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10. 


UNIVER?^ITY  OF  CALIFORNIA 
CALIFORNIA  "E  OF  MEDICINE 


IRVINE,  CALffORWfA  Wm 


1      /  '^  >v 


HISTORY  OF  MEDICINE 


■WITH  THE 


CODE  OF  MEDICAL  ETHICS 


NATHAN  SMITH  DAVIS,  A.  M.,  M.  D.,  LL.D. 

Emeritus  Dean  and  Professor  of  Medicine,  Nortliwestern  University 
Medical  School,  Chicago. 


CLEVELAND  PRESS 
CHICAGO 


Copyright  1903 

BY   THE 

CLEVELAND  PRESS 
(All  Righti  Reserved.) 


PREFACE. 


From  1892  to  1897,  both  years  included,  I  gave  to  the 
senior  class  of  the  Northwestern  University  Medical  School 
each  year  a  course  of  fourteen  or  fifteen  lectures  on  the 
history  of  medicine  from  the  earliest  periods  of  which  we 
have  any  records,  to  the  end  of  the  nineteenth  century  of 
the  Christian  era.  My  object  was  to  trace  with  as  much 
clearness  and  accuracy  as  possible  the  origin  and  pro- 
gressive development  of  the  various  branches  of  medical 
science  and  practice,  and  their  intimate  connection  with 
the  progress  of  all  other  departments  of  human  knowledge. 

The  following  chapters,  constituting  this  book,  have 
been  written  and  revised  from  the  notes  used  in  the  lecture 
room ;  each  chapter  representing  a  lecture  in  the  order  in 
which  it  was  given. 

I  have  consented  to  their  publication  in  a  neat,  but 
inexpensive  volume,  in  the  hope  that  they  might  attract 
the  attention  of  a  large  proportion  of  both  students  and 
practitioners  of  medicine ;  and  thereby  diffuse  a  better 
knowledge  of  the  origin,  progress,  and  present  status  of 
the  true  science  and  art  of  medicine. 

NATHAN  S.  DAVIS. 


HISTORY  OF  MEDICINE. 


CHAPTER  I. 


THE  CONDITION  OF  MEDICINE  PRIOR  TO  THE  TIME  OF  HIPPO- 
CRATES  THE   GREAT,    460   B.    C. 

It  was  said  by  Hippocrates  that  "The  physician  must 
know  what  others  have  known  or  he  is  constantly  liable 
to  deceive  both  himself  and  others."  Consequently,  if 
the  physician  would  know  what  others  have  known,  he 
must  study,  not  only  the  present  text-books  and  litera- 
ture of  the  profession,  but  he  must  also  patiently  review 
its  past  history  from  the  earliest  ages  through  its  suc- 
cessive stages  of  development  and  the  relations  of  that 
development  to  the  progress  of  man  in  all  other  depart- 
ments of  human  knowledge. 

For  every  important  branch  of  knowledge  bears  some 
relation  to  every  other  branch,  and  in  prosecuting  our 
study  of  the  history  of  medicine,  we  shall  find  that  in 
every  stage,  and  in  every^  country,  its  condition  and  prog- 
ress has  been  intimately  connected  with  the  coincident 
condition  and  progress  in  philosophy,  religion  and  science. 

The  earliest  indications  of  progress  in  civilization  have 
been  traced  in  Egypt  and  southern  and  central  western 
Asia,  occupied  by  the  Egyptians,  Hindoos,  Chinese,  Baby- 
lonians, Assyrians,  Phoenicians,  Medes,  Persians,  Jews 
and  Greeks ;  and  in  time  extending  to  5,000  or  6,000  years 
before  the  commencement  of  the  Christian  era. 

During  the  6,000  years  just  mentioned  all  these  an- 
cient nations,  except  the  Greeks,  had  been  either  de- 
stroyed, scattered  or  reduced  to  a  dormant  or  non-progres- 
sive condition,  leaving  at  present,  as  the  chief  evidences 
of  their  once  prosperous  and  semi-civilized  condition,  the 
fragments  of  broken  monuments ;  the  remains  of  ruined 
cities,  some  of  them  long  since  buried,  but  found  to  con- 


tain  statues,  images,  implements  and  inscriptions ;  and  in 
Egypt  the  pyramids  with  their  mummified  inhabitants. 
From  all  these  fragmentary  sources  of  information,  suf- 
ficient has  been  gathered  to  show  that  all  these  nations 
had  made  much  progress  in  the  mechanical  arts  and  math- 
ematics, while  their  ideas  of  philosophy  and  religion  were 
inseparably  mixed.  Their  philosophy  consisted  in  the 
belief  that  the  world  was  made  of  four  elements — fire, 
air,  water  and  earth — all  pervaded  by  spiritual  qualities, 
and  the  first  named  most  refined,  possessed  of  intelli- 
gence, and  identical  with  the  soul  or  spirit  of  man.  Their 
religion,  except  that  of  the  Jews,  consisted  in  the  recog- 
nition and  worship  of  deities  almost  without  number,  and 
generally  represented  by  some  material  image  or  statue. 
Everything  pertaining  to  human  life  and  destiny  was 
thought  to  be  controlled  by  good  or  evil  spirits,  and  in 
consequence  a  God  or  Goddess  was  supposed  to  rule  over 
every  line  of  blessings  and  curses  or  evils  that  visited  them. 
As  a  logical  necessity,  they  attributed  all  forms  of  sickness, 
or  mental  and  bodily  suffering,  to  the  displeasure  of  some 
one  of  their  deities,  and  of  course  to  such  deities  they 
turned  with  petitions,  prayers  and  sacrifices,  for  relief. 

From  the  numerous  but  imperfect  data  furnished  by 
the  researches  of  antiquarians  and  historians,  it  has  been 
inferred  that  the  ancient  kingdom  of  Egypt  was  founded 
as  early  as  6,000  B.  C,  and  its  people  reached  the  climax 
of  their  progress  towards  what  we  call  civilization  between 
4000  B.  C.  and  3000  B.  C.,  when  the  most  famous  pyramid 
and  the  noted  Sphinx  were  constructed,  during  the  reign  of 
Chufu  or  Cheops. 

The  most  ancient  and  renowned  of  the  medical  divin- 
ities of  that  country  was  Isis,  said  to  have  been  both 
sister  and  wife  of  Osiris,  for  it  was  not  uncommon  in 
those  days  for  brothers  to  marry  their  own  sisters.  The 
divine  honors  of  Isis  were  founded  on  the  great  medical 
skill  she  displayed  in  recalling  to  life  her  son  Horus.  If 
we  may  credit  this  legend  it  will  be  perceived  that  the 
practice  of  medicine  by  the  female  sex  is  by  no  means  of 
modern  origin. 


Among  the  other  medical  divinities  were  Imhotep, 
sometimes  called  the  Egyptian  ^sculapius,  whose  tem- 
ple was  at  Memphis;  Pacht,  who  was  represented  with 
the  head  of  the  cat,  and  was  regarded  as  the  special  deity 
of  parturient  women ;  and  Thout  or  Taaut,  who  was  some- 
times represented  with  the  head  of  the  dog,  and  was  hon- 
ored as  the  inventor  of  the  healing  art,  and  of  all  other 
arts.  To  him  has  been  attributed  the  authorship  of  the 
oldest  Egyptian  medical  works,  said  to  have  been  origi- 
nally inscribed  on  pillars  of  stone.  At  a  later  period  the 
inscriptions  were  copied  on  papyrus,  and  made  to  consti- 
tute a  part  of  the  so-called  sacred  "Hermetic  Books".  Ac- 
cording to  the  medical  historian,  Baas,  the  prescriptions  in 
these  books  were  regarded  as  derived  directly  from  the 
Gods,  and  from  them  no  one  might  deviate  without  be- 
coming liable  to  severe  penalties.  Probably  all  that  now 
remains  of  these  books  may  be  found  in  two  papyri,  one  at 
Leipzig  and  the  other  at  Berlin.  The  fact  that  they  con- 
tain remedies  for  the  treatment  of  each  part  of  the  body, 
suggests  that  the  medical  men  were  then  as  much  devoted 
to  specialties  as  at  the  present  day. 

The  universal  belief  that  both  diseases  and  their  rem- 
edies were  derived  from  and  controlled  by  their  deities, 
necessarily  caused  the  office  of  priest  and  physician  to  be 
united  in  the  same  person,  and  the  temples  for  worship  be- 
came the  chief  places  of  resort  for  the  sick.  The  most 
noted  of  these  temples  in  Egypt  were  at  Thebes,  Mem- 
phis, and  Heliopolis.  The  names  of  four  physicians,  who 
are  represented  as  practising  medicine  between  5,000  B. 
C.  and  4,000  B.  C,  have  been  preserved  and  are  Teta, 
Tseshorta,  Nebsuchet  and  Chui.  The  first  two  were  also 
kings,  and  the  last  was  an  oculist. 

There  are  indications  that  considerable  progress  had 
been  made  in  the  practice  of  surgery,  especially  during  the 
reign  of  the  Pharaohs,  who  were  much  engaged  in  war. 
Their  surgeons  are  credited  with  having  performed  ampu- 
tations, lithotomy,  the  removal  of  cataract,  the  extraction 
of  foreign  bodies  and  the  dressing  of  wounds.  Their  med- 
ical practice  consisted  largely  in  conjurations,  prayers  and 


8 

soothsaying,  but  they  sometimes  administered  both  emet- 
ics and  purgatives. 

The  ancient  Babylonians,  Assyrians,  Phcenicians,  Medes, 
Persians  and  Jews  occupied  the  central  portion  of  West- 
ern Asia,  between  the  Caspian  Sea  and  the  Persian  Gulf, 
and  were  in  their  most  prosperous  condition  from  4,000 
B.  C.  to  1,000  B.  C.  They  are  supposed  to  have  succeeded 
a  more  ancient  people  called  Accadians,  or  descendants  of 
Accad,  and  were  all  of  Semitic  origin.  All  these  nations 
had  more  or  less  commercial  intercourse  with  the  Egyp- 
tians, and  as  far  as  can  be  determined  by  such  scanty  rem- 
nants of  their  work  as  have  been  preserved,  their  ideas  of 
philosophy,  reUgion  and  medicine  were  similar.  Like  the 
Egyptians  they  invented  a  multiplicity  of  deities  to  whom 
they  attributed  all  the  events  of  life,  whether  good  or  evil. 

By  the  Assyrians  and  Persians  the  chief  God  of  healing 
was  called  Ainyama,  and  Thrita  was  the  God  of  physicians. 

With  the  Phoenicians  the  chief  medical  deity  was  Es- 
mun,  the  eighth  of  the  Cabiri ;  and  as  a  people  they  appear 
to  have  been  more  enterprising  and  intellectually  pro- 
gressive than  any  of  their  contemporaries  except  the 
Greeks;  for  the  Phoenicians  were  not  only  commercially 
active  and  given  to  colonizing,  but  to  them  we  owe  the 
art  of  writing  with  letters,  instead  of  the  cuneiform  marks 
of  the  Assyrians  and  the  hieroglyphics  of  the  Eg>'ptians. 
To  them  we  also  owe  the  invention  of  the  Zodiac,  with 
its  division  into  signs,  degrees  and  minutes,  and  the  divis- 
ion of  the  day  into  twelve  equal  hours.  Their  most  im- 
portant temples,  both  for  learning  and  worship,  are  said 
to  have  been  located  on  the  islands,  Tyros,  Arados  and 
Dilmoun,  near  the  mouth  of  the  Tigris,  more  than  2,000 
years  B.  C.  But  almost  the  only  fragment  left  to  indi- 
cate anything  concerning  their  progress  in  medicine  is 
one  chapter  of  the  Papyrus  Ebers  at  Leipzig,  contributed  by 
a  physician  of  Byblos.  The  medical  historian,  Baas  repre- 
sents their  supreme  deity,  called  Baal-Zebul  (the  Beelzebub 
of  the  Bible)  as  a  God  of  Medicine. 

The  Jews  or  Hebrews,  constituting  a  distinct  division 
of  the  Semitic  race,  are  first  made  known  to  us  as  a  no- 


madic  people,  inhabiting  the  country  bordering  on  the 
middle  Euphrates  and  Tigris  called  Palestine.  At  an 
early  period  they  visited  Egypt,  but  soon  returned  to  Pal- 
estine. At  a  later  period,  probably  not  far  from  2,000  B. 
C,  they  emigrated  again  into  Egypt,  where  they  remained 
about  400  years,  when  they  were  led  back  to  Palestine  by 
Moses  (the  Egyptian  Mesu)  between  1,500  B.  C.  and  1,600 
B.  C.  Their  leader  and  great  law-giver,  Moses,  had  been 
educated  in  all  the  learning  of  Egypt  as  a  member  of  the 
royal  family,  and  was  consequently  familiar  with  the  re- 
ligion, arts  and  medicine  of  that  country.  But  he  chose 
to  cast  his  lot  with  his  own  people,  and  in  the  Code  of 
Laws  he  framed  for  their  government  he  made  one  im- 
portant provision  dififering  from  the  laws  of  all  the  other 
nations  of  that  time.  It  consisted  in  the  proclamation  of 
one  God  as  the  creator  and  preserver  of  all  things,  accom- 
panied by  the  injunction  that  Him,  and  Him  only,  should 
the  people  worship.  All  other  divinities  or  deities  were 
declared  to  be  false  and  their  worship  forbidden  under  the 
severest  penalties.  But  he  recognized  the  existence  and 
influence  of  evil  spirits,  or  demons,  the  chief  of  which  was 
Satan,  or  the  Devil.  Yet,  like  the  people  of  all  the  other 
countries,  the  Hebrews  regarded  the  prevalence  of  dis- 
eases, and  especially  of  important  epidemics,  as  punish- 
ments inflicted  by  their  Deity  on  account  of  their  sins. 
Consequently,  for  relief,  they  resorted  to  repentance, 
prayer,  and  the  interposition  of  the  priests  officiating  in 
their  places  of  worship,  rather  than  to  the  administration 
of  medicines.  They  thereby  combined  the  functions  of 
priest  and  physician  in  the  same  persons,  even  more  than 
did  the  Egyptians  or  Assyrians. 

While  we  find  a  remarkable  absence  of  any  mention  of 
either  surgical  or  strictly  medical  practice  among  the  early 
Hebrew  people,  their  great  lawgiver,  Moses,  gave  them 
the  earliest  elementary  code  of  public  hygiene  of  which  we 
have  any  record.  It  contained  specific  directions  in  regard 
to  the  kind  and  preparation  of  food;  the  slaughtering  of 
animals ;  the  burial  of  the  dead ;  the  regulation  of  marriage 
and  sexual  relations;  the  diagnosis  and  isolation  of  cases 


10 

of  leprosy,  and  some  other  contagious  or  infectious  dis- 
eases, and  the  strict  prohibition  of  artificial  abortion.  The 
only  surgical  procedure  included  was  that  of  circumcision, 
which  was  to  be  performed  by  the  priests  of  the  tribe  of 
Levi.  After  this  people  had  been  repeatedly  conquered 
and  compelled  to  mingle,  as  captives,  with  the  neighbor- 
ing nations,  they  adopted  many  medical  and  surgical  prac- 
tices derived  from  both  Egyptians  and  Assyrians,  as  may  be 
seen  in  the  book  of  the  Talmud,  written  during  the  third 
century  before  the  Christian  era. 

Of  the  condition  of  medicine  among  the  people  orig- 
inally occupying  that  part  of  Asia  now  called  India  and 
China,  we  really  have  no  knowledge,  Alax  Mueller  claims 
that  the  progress  of  the  inhabitants  of  those  countries  in 
religion,  philosophy  and  medicine  was  earlier  than  in  either 
those  of  Egypt  or  Greece.  The  present  inhabitants  of 
India,  however,  are  supposed  to  have  immigrated  from  the 
north  and  settled  in  Bengal  about  the  year  2000  B.  C. 
According  to  the  traditional  mythology  of  these  people, 
their  supreme  God  of  Medicine,  called  Dhanvantari,  was 
sent  to  the  earth  by  Indra  when  the  world  was  sick.  He  is 
supposed  to  have  educated  many  physicians,  among  whom 
was  Susruta,  the  son  of  the  fakir-king,  Visvamithra  and 
Charaka,  and  to  whom  is  attributed  a  remarkable  work 
called  the  Yayurveda,  in  which,  we  are  told  by  Baas,  all 
diseases  are  divided  into  "natural  and  supernatural",  and 
"are  ascribed  to  an  unequal  or  perverted  action  of  the  five 
common  elements,  ether,  air,  fire,  water  and  earth.  These, 
however,  in  the  first  place,  through  the  influence  of  food, 
season,  conditions  of  the  atmosphere  and  the  climate,  form 
proximate  causes  of  disease,  while  corruption  of  the  three 
elementary  fluids,  bile,  mucus  and  air,  is  looked  upon  as 
the  remote  cause". 

The  Yayurveda  of  Susruta  and  the  Atharvaveda  con- 
stitute the  medical  part  of  the  Vedas  or  sacred  books  of 
India.  They  are  supposed  to  have  originated  from  1000 
B.  C.  to  1500  B.  C,  and  are  the  earliest  writings  belong- 
ing to  that  country  of  which  we  have  any  positive  knowl- 
edge. 


II 

Max  Mueller  contends  that  all  the  writings  constituting 
the  Vedas  existed  and  were  transmitted  only  by  oral  tra- 
ditions until  the  reign  of  Azoka,  259  B.  C.  to  222  B.  C,  or 
more  than  a  century  later  than  the  time  of  Hippocrates 
in  Greece.  The  beginning  of  the  book  attributed  to  Char- 
aka-Susruta,  now  being  translated  into  English,  has  the 
form  of  Aphorisms,  of  which  the  following  may  serve  as 
specimens : 

"Mind,  Soul  and  Body,  this  trinity,  called  person,  rest- 
eth  on  union  like  three  sticks  (standing  against  each  other). 
Upon  that  trinity  everything  rests". 

"Of  all  diseases,  physical  and  mental,  the  causes  in 
brief  are  of  three  kinds,  viz :  Adverse  or  excessive  corre- 
lation, or  want  of  correlation  of  time,  mind,  and  the  objects 
of  the  senses". 

"Body  and  mind  are  regarded  as  the  subjects  in  which 
health  and  disease  co-inhere;  parity  of  correlation  being 
the  cause  of  health". 

"The  Soul  is  immutable  and  eternal;  faculties,  the  at- 
tributes of  matter,  and  the  senses,  are  the  causes  of  con- 
sciousness. The  Soul  is  the  eternal  witness,  for  it  views 
all  actions,  without  being  itself  affected  by  any  of  them". 

"Wind,  bile  and  phlegm  have  been  said  to  be  the  causes 
of  all  bodily  diseases.  The  qualities  of  passion  and  darkness 
have  again  been  indicated  to  be  the  causes  of  mental  dis- 
eases". (See  translation  of  Charaka-Samhita,  published  by 
Abinash  Chandra  Kaviratua.) 

Baas  says  that  the  oldest  of  the  Veda  books  called  the 
Rigveda,  contains  simple  charms,  of  which  he  quotes  the 
following : 

"Ye  breezes,  healing  blow,  and  waft  his  pain  away; 
The  Gods  have  sent  you  forth  with  stores  of  healing 

drugs." 
Again : 
"Healing  are  the  watery  billows,  water  cools  the  fever's 

glow ; 
Healing  against  every  plague,  health  to  thee  brings 

water's  flow." 


12 

The  last  two  lines  may  be  taken  as  forestalling  our 
modem  hydrotherapy  or  bath  treatment  of  fevers. 

The  general  adoption  of  the  religious  doctrines  of 
Brahma,  with  its  division  of  the  people  in  castes,  and  the 
complete  rule  of  the  priests  about  800  B.  C,  seems  to  have 
arrested  all  further  progress  in  either  medicine  or  general 
science. 

The  introduction  of  the  Buddhistic  doctrines  four  cen- 
turies later,  and  considerable  commercial  intercourse  with 
Greece,  evidently  caused  some  modifications ;  but,  notwith- 
standing these,  the  native  people  of  both  India  and  China 
have  remained  in  a  remarkably  non-progressive  condition 
for  the  last  4,000  years. 

The  Chinese  are  even  more  fanciful  than  the  Hindoos, 
and  yet  more  fatalistic  in  both  religion  and  medicine  than 
the  followers  of  ]\Iahomet.  They  appear  to  attribute  all 
diseases  of  an  epidemic  character  to  the  influence  of  spir- 
its, aided  by  cold  or  warm  winds.  In  their  pharmacology, 
as  compiled  by  Lee-Sheo-Tshin,  are  included  "elephants' 
bile,  dried  spiders,  bugs,  toads,  lizards,  snakes,  claws,  ears, 
tongues,  hearts  and  livers  of  numerous  animals,  excrement, 
dragon-bone,  cotton,  ivory,  musk,  rheubarb,  gentian, 
camphor,  etc."  (Baas.)  A  summary  of  their  ideas  of 
anatomy  and  physiology  as  given  by  Baas,  is  as  follows: 
"The  Chinese  assume  the  existence  of  six  chief  organs  in 
which  the  'moisture'  is  located,  viz:  The  heart,  liver,  two 
kidneys,  spleen  and  lungs;  six  others  in  which  is  the 
seat  of  'warmth,'  viz:  The  small  and  large  intestine,  the 
gall-bladder,  the  stomach  and  the  urinary  apparatus.  They 
enumerate  365  bones,  including  8  for  the  male  and  6  for 
the  female  cranium;  12  ribs  in  men  and  14  in  women". 
Instead  of  the  fire  and  earth  of  the  other  contemporary  na- 
tions, the  Chinese  regard  wood  and  metal  as  elements, 
and  heat  and  moisture  as  fundamental  qualities. 

Did  our  time  permit,  traces  of  the  same  theurgic  ideas 
and  practices  in  relation  to  medical  matters  could  be  found 
among  all  the  other  ancient  inhabitants  of  Asia,  Africa, 
the  islands  of  the  Pacific  and  of  the  Indian  oceans,  as  well 


13 

as  among  all  the  aboriginal  tribes  and  nations  of  North 
and  South  America, 

Everywhere,  in  the  early  ages,  diseases  were  attributed 
to  supernatural  agencies,  as  either  the  work  of  demons  or 
evil  spirits,  or  inflictions  of  the  Gods  as  punishments  for 
the  sins  of  the  people;  and  as  a  consequence  the  priests 
were  the  chief  physicians.  Indeed  it  might  be  said  that 
their  medicine  was  only  a  part  of  their  religion;  and 
whether  they  worshipped  one  deity  or  many,  they  all  per- 
sistently claimed  that  the  human  body,  dead,  was  more 
sacred  than  while  living,  and  that  the  study  of  human 
anatomy  by  dissections  was  sacrilege.  In  consequence  of 
that  doctrine  and  the  absence  of  a  knowledge  of  analytical 
chemistry,  the  science  and  art  of  medicine  remained 
substantially  stationary  during  all  the  past  seven  or  eight 
thousand  years  among  all  the  early  or  aboriginal  inhabi- 
tants of  Asia,  Africa  and  North  and  South  America.  And 
it  is  to  be  regretted  that  we  still  have  some  among  us  who, 
notwithstanding  all  our  progress  in  science,  philosophy 
and  art,  still  regard  medicine  as  a  part  of  their  religion,  and 
consequently  when  sick  they  call  for  prayers  instead  of 
physic — the  priest  instead  of  the  physician.  Such  people 
appear  to  be  incapable  of  comprehending  the  fact  that  the 
God  they  worship — the  Creator  of  the  universe — himself 
works  with  materials  and  in  accordance  with  laws,  and 
that  the  true  office  of  prayer  is  for  His  guidance  in  the 
choice  of  materials  and  for  wisdom  in  their  application. 

The  earliest  traces  of  medical  history  in  Europe  have 
been  found  among  the  ruins  of  the  buried  cities,  the  broken 
monuments  and  works  of  art,  and  the  historical  poems  of 
Homer,  belonging  to  the  people  called  Hellenes  of  ancient 
Greece.  They  unmistakably  point  to  a  period  of  time  coin- 
cident with  the  period  of  greatest  prosperity  in  Egypt, 
Assyria  and  Phoenicia,  i.  e.,  from  6000  B.  C.  to  1000  B.  C. 

And  the  Hellenes,  or  Greeks,  like  their  contempora- 
ries in  Egypt,  assumed  the  existence  of  numerous  deities, 
both  male  and  female,  or  Gods  and  Goddesses,  to  whom 
they  attributed  the  control  of  nearly  all  the  affairs  of  life.. 
Chief  among  these  were  Apollo,  Pluto,  Hercules,  Juno, 


Artemis  and  Coronis.  According  to  Homeric  mythology, 
Apollo  was  the  ruler  of  Pestilence ;  Artemis,  the  Goddess 
of  Parturition ;  Pluto,  the  ruler  of  Hades ;  and  Hercules 
was  the  discoverer  of  warm  baths.  The  special  God  of 
Medicine,  however,  was  ^sculapius,  the  mythical  son  of 
'  Apollo  and  Coronis. 

Another  fable  represents  him  as  having  immigrated 
from  ^lemphis  in  Egypt,  and  to  have  received  instruction 
in  the  healing  art  by  Chiron,  who  is  represented  in  Greek 
art  as  half  horse  and  half  man.  The  very  great  skill  ac- 
quired by  .^sculapius  in  restoring  the  sick  to  health,  is 
said  to  have  so  offended  Pluto,  the  keeper  of  Hades,  that  he 
induced  Zeus  to  slay  him  with  a  thunderbolt. 

By  some  writers  .^sculapius  is  represented  to  have 
been  a  real  person,  living  about  1250  B.  C,  who  after 
death  was  deified,  and  the  temples  erected  by  his  followers, 
both  for  the  reception  of  the  sick  and  for  worship,  were 
called  .(Esclepieia,  and  those  who  administered  in  them 
were  called  ^sclepiadae,  on  whom  devolved  the  double 
duties  of  physician  and  priest.  These  temples  or 
i^sclepieia  were  established  at  Tricca,  Epidaurus,  Rhodes, 
Cos,  Cnidos,  Pergamos,  and  other  places ;  but  those  most 
celebrated  were  at  Cos,  Cnidos  and  Rhodes.  The  his- 
torian, Herodotus,  very  properly  calls  Homer  the  Manu- 
facturer of  Gods ;  yet  in  the  poems  of  Homer,  ^sculapius 
is  represented  only  as  a  physician  of  extraordinary  skill  and 
the  father  of  Machaon  and  Podalirius  who  were  the  chief 
army  surgeons  as  well  as  warriors  in  the  Hellenic  wars 
described  by  the  poet.  He  also  alludes  to  female  physi- 
cians, especially  to  Hellen  and  Agamede,  "who  all  heal- 
ing herbs  well  knew."  And  Paeon  is  called  the  divine 
healer  of  wounded  Gods,  as  in  the  following : 
"Thus  he  who  shakes  Olympus  with  his  nod, 
Then  gave  to  Paeon's  care  the  bleeding  God. 

(Ares.) 
With  gentle  hand  the  balm  he  poured  around, 
And  healed  the  immortal  flesh  and  closed  the  wound." 
The  medicine  of  the  Greeks  prior  to,  and  during,  the 
Homeric  period  was  mostly  surgical.    He  makes  very  lit- 


15 

tie  allusion  to  internal  diseases,  once  only  alluding  to  an 
epidemic  of  nine  days  produced  by  the  darts  of  Apollo,  and 
to  a  pestilence  in  Crete  during  the  siege  ^f  Troy.  The 
Homeric  period  proper  is  supposed  to  have  been  the  9th 
century  B.  C.  Up  to  that  period  and  for  three  centuries 
later,  they  had  no  written  language,  all  knowledge  being 
acquired  and  transmitted  by  oral  instruction  from  one  gen- 
eration to  another.  The  earliest  writing  found  in  Greece 
was  on  small  pieces  of  leather  executed  about  600  B.  C, 
and  inscriptions  on  tablets  in  the  yEsclepieia. 

It  was  not  until  the  introduction  of  papyrus  from 
Egypt  and  the  art  of  writing  with  letters  from  Phoenicia 
that  a  real  literature  was  commenced  in  Greece.  Hippo- 
crates, about  450  B.  C.,  is  represented  to  have  been  the 
first  physician  to  commit  his  views  concerning  diseases 
and  their  treatment  to  writing;  and  is  therefore  justly 
styled  the  "father  of  medical  literature",  as  well  as  the 
father  of  medicine. 

While  the  Greeks,  like  the  other  primitive  nations,  at- 
tributed all  things  to  the  control  of  invisible  spirits,  good 
or  evil ;  and  regarded  the  world  as  composed  of  the  four 
elements,  fire,  air,  water,  and  earth,  they  displayed  a  far 
greater  intellectual  activity  in  studying  the  relation  of 
these  elements  to  physical  changes  constantly  taking  place 
under  their  observation.  This  early  gave  rise  to  the  ev- 
olution of  theories  or  so-called  schools  of  philosophy.  The 
earliest  of  these  schools  of  which  we  have  any  account, 
called  the  Ionic,  was  founded  by  Thales,  of  Miletus,  a  pupil 
of  the  Egyptian  priests,  about  600  B.  Q.  He  assumed  that 
reason,  spirit  or  mind  and  God  were  one ;  and  that  water 
and  spirit  were  the  first  cause  of  all  things,  and  preserved 
their  identity  throughout  all  the  changes  in  what  he  called 
secondary  elements — fire,  air  and  earth.  Half  a  century 
later,  Heraclitus,  of  Ephesus,  taught  that  fire  instead  of 
water  was  the  primal  matter,  and  enmity  between  the  par- 
ticles of  matter  was  the  cause  of  decay,  and  friendship  the 
cause  of  their  union  in  all  the  visible  forms  of  matter.  He 
also  regarded  the  embryo  in  impregnation  to  be  derived 


i6 

wholly  from  the  male  semen,  and  the  uterus  as  the  recep- 
tacle for  its  development, 

Anaxagoras,  of  Clasomena,  in  Asia  Minor,  about  460 
B.  C,  said  to  have  been  the  teacher  of  Pericles,  in  addition 
to  some  very  advanced  views  in  astronomy,  taught  that 
matter  and  spirit  were  "the  elementary  principles  of  the 
world";  the  first  being  composed  of  innumerable  atoms 
which  were  moulded  or  transformed  by  the  active  creative 
spirit,  into  all  bodies  animate  and  inanimate.  He^repre- 
sented  that  the  animal  body  was  nourished  by  appropri- 
ating to  itself  materials  similar  to  those  of  which  it  was  con- 
stituted ;  and  that  diseases  were  caused  by  the  penetration 
of  bile  into  the  blood  vessels,  lungs,  and  pleura.  About 
the  same  time  Empedocles,  of  Agrigentum,  while  admit- 
ting that  fire,  air,  water  and  earth  were  the  elements  of  all 
things,  claimed  that  no  element  could  be  destroyed;  that 
all  changes  in  bodies  were  only  changes  in  the  arrange- 
ment of  elements  or  atoms,  and  that  all  bodies  were  formed 
by  the  friendship  (attraction)  and  destroyed  by  the  enmity 
(repulsion)  of  the  elements  entering  into  their  composi- 
tion. His  medical  views  are  set  forth  by  Baas  as  follows: 
"The  sex  in  the  embryo  was  determined  by  the  predom- 
inance of  heat  or  cold  in  the  parents".  He  believed  the 
embryo  was  nourished  through  the  navel,  and  to  him  we 
owe  the  terms  amnion  and  chorion.  Death,  however,  re- 
sulted from  the  extinction  of  heat,  the  effect  of  the  separa- 
tion of  the  elements.  Expiration  arose  from  motion  of 
blood  upwards,  and  consequently  of  the  air  upwards;  in- 
spiration in  an  inverse  way. 

Although  he  referred  the  cure  of  diseases  to  the  Gods, 
nevertheless  it  is  said  that  he  endeavored  to  banish  epi- 
demics by  building  bonfires  and  draining  swamps,  with- 
out waiting  for  his  divinities  to  act ;  more  rational,  certainly, 
than  some  at  the  present  day. 

Another  coincident,  and  perhaps  more  influential 
school  was  that  of  Pythagoras,  of  Samos,  established  about 
550  B.  C,  and  sometimes  called  the  Italian  School.  Pytha- 
goras visited  Egypt  where  he  became  acquainted  with  the 
mathematics  and  other  branches  of  Egyptian  learning,  and 


17 

for  a  time  was  a  pupil  of  Onuphis,  of  Heliopolis.  He  at- 
tempted to  build  a  theory  of  the  universe  founded  on  num- 
bers. Unity,  or  monad,  was  the  beginning  of  all  things, 
the  symbol  of  perfection,  the  Anima  Mundi,  or  God.  Duad, 
or  number  2,  represented  the  material  world.  Visible 
bodies  are  formed  by  combinations  of  an  endless  variety 
of  numbers  one  and  two  or  the  monad  and  the  duad.  He 
taught  that  the  Anima  Mundi,  or  God,  was  the  light  of 
the  universe  and  self-created.  That  the  Anima,  or  mind  or 
soul  of  man,  was  an  emanation  from  God  and  immortal, 
while  his  body  after  death  underwent  decay,  and  that  the 
basis  of  life  was  heat.  Physiologically,  he  represented  new 
animal  life  as  originating  from  the  semen,  a  fluid  emanat- 
ing from  the  brain.  A  proper  regulation  of  diet  and  ex- 
ercise was  regarded  as  necessary  for  the  promotion  of 
health.  The  application  of  salves  and  poultices  was  rec- 
ommended, but  surgical  operations  were  discouraged.  As 
diseases  were  attributed  to  demons  or  evil  spirits  their 
cure  was  sought  by  prayer,  sacrifices  and  music. 

He  endeavored  to  form  his  followers  into  a  club  under 
a  pledge  to  observe  certain  rules  of  living. 

Alcmaeon,  of  Crotona,  a  pupil  of  Pythagoras,  was  one 
of  the  earliest  to  study  comparative  anatomy  by  the  sys- 
tematic dissection  of  animals.  To  him  is  attributed  the 
discovery  of  the  optic  nerves  and  Eustachian  tubes ;  and  he 
explained  hearing  by  claiming  that  the  ear  contained  a 
vacuum  in  which  the  sounds  were  produced.  When 
Polycrates  banished  the  Pythagorians  from  Crotona,  many 
of  them  became  itinerant  physicians,  and  were  perhaps  the 
first  to  visit  patients  at  their  homes. 

The  Materialistic  school,  founded  chiefly  by  Democri- 
tus,  of  Abdera,  about  450  B.  C.,  also  exerted  considerable 
influence  on  the  development  of  medical  ideas.  The  dis- 
tinctive features  of  the  philosophy  of  this  Sect,  or  School, 
were:  ist.  The  denial  of  all  Anima,  Spirit,  or  God,  and 
substituting  therefore  Necessity,  or  Fate.  2d.  The  declar- 
ation that  all  things  originate  in  matter  composed  of  in- 
finitely minute  and  numerous  atoms,  in  which  inhere  order, 
position,  form  and  motion.     The  atoms  diflfer  in  size  and 


i8 

weight  in  consequence  of  which  their  combination  pro- 
duce the  four  elements,  fire,  air,  water  and  earth.  The 
functions  of  sensibility  and  mental  phenomena  were  at- 
tributed to  very  small,  round,  smooth  atoms  in  motion. 
These  were  supposed  to  be  particularly  active  in  the  heart, 
causing  anger;  in  the  liver,  desires;  and  in  the  brain, 
thought.  It  was  claimed  that  a  healthy  brain  produced 
mental  health,  and  a  diseased  brain  mental  disorder; 
thereby  anticipating  by  more  than  2,000  years  some  of  the 
cerebral  and  mental  pathology  of  the  present  day. 

Besides  the  foregoing  schools  of  so-called  Philosophy 
and  Medicine,  there  were  also  the  Sophists,  founded  by 
Gorgius,  of  Loentium;  the  Socratists,  founded  by  Socra- 
tes, perhaps  the  greatest  of  Grecian  philosophers  and  the 
strongest  opponent  of  the  materialistic  doctrines  of  Demo- 
critus ;  and  the  schools  more  directly  connected  with  the 
yEsclepieia,  or  temples  of  ^sculapius,  to  which  the  greater 
number  resorted  for  treatment,  and  which  were  the  chief 
repositories  of  the  tablets  on  which  were  inscribed  many 
facts  relating  to  cases  of  disease  and  their  remedies. 

I  have  thus  far  endeavored  to  give  a  brief  statement 
of  the  condition  of  learning  among  all  the  peoples  or  na- 
tions of  which  we  have  any  authentic  records  prior  to  the 
advent  of  Hippocrates,  about  the  middle  of  the  fifth  century 
before  the  Christian  era. 

We  have  seen  that  among  them  all  the  real  progress 
in  development  was  limited  to  the  mechanical  arts  and 
mathematics.  The  construction  of  implements,  houses, 
cities,  images,  pictures,  statues  and  monuments  was  car- 
ried to  a  high  degree  of  perfection ;  and  in  the  science  of 
numbers  they  showed  no  lack  of  proficiency.  But  with- 
out any  analytical  chemistry,  anatomy  or  biology,  they 
had  no  means  of  determining  the  composition  and  prop- 
erties of  the  visible  bodies  around  them,  nor  of  the  com- 
position and  functions  of  the  structures  and  organs  of 
which  their  own  bodies  were  composed.  Hence,  their 
only  conclusion  was  that  the  four  visible  and  tangible 
forms  of  matter:  fire,  air,  water  and  earth,  were  the  real 
elementary  materials  of  which  the  world  was  made ;  and 


19 

that  the  four  visible  fluids  coming  from  a  living  animal 
body:  blood,  phlegm,  bile  and  black  bile,  were  the  ele- 
mentary humors  which,  when  natural,  constituted  health, 
and  when  disordered,  constituted  disease.  But  the  mys- 
terious evidences  of  design  and  incomprehensible  wisdom 
displayed  in  every  department  of  nature  led  them  instinc- 
tively or  intuitively  to  refer  the  authorship  of  the  whole 
to  invisible  spirits  or  Gods.  And  having  accepted  the  ex- 
istence and  power  of  spirits  or  Gods,  what  more  logical 
than  to  attribute  the  good  things  to  good  spirits,  and  the 
bad  things  to  evil  spirits.  Equally  logical  and  necessary 
was  the  next  step,  to  attribute  all  diseases  either  to  the  evil 
spirits  or  demons,  or  as  punishments  by  the  good  spirits 
on  account  of  the  sins  of  the  afflicted.  And  if  the  dis- 
eases were  inflicted  by  the  Gods,  good  or  evil,  of  course 
the  chief  remedy  must  consist  in  prayers,  sacrifices  and 
penances  for  propitiating  the  offended  deities,  and  for  this 
the  priest  becomes  the  physician.  Thus,  we  have,  in  a 
few  words,  the  actual  development  of  medicine  and  its 
relation  to  other  departments  of  human  knowledge  from 
the  beginning  of  man  to  the  days  of  Hippocrates. 


20 


CHAPTER  II. 

HISTORY   OF   HIPPOCRATES, — HIS   WRITINGS,   AND   THE   PROG- 
RESS OF  MEDICINE  DURING  THE  FIV'E  SUCCEEDING 
CENTURIES,  OR  TO  THE  TIME  OF  GALEN, 
150   A.    D. 

The  preceding  chapter  had  brought  our  history  of 
medicine  to  the  middle  of  the  fifth  century  B.  C,  a  period 
when  Grecian  civilization  and  power  had  reached  their 
zenith.  Greece  had  victoriously  closed  her  wars  with  Per- 
sia, and  in  statesmanship,  in  works  of  art,  in  history,  in 
schools  of  philosophy,  and  in  physical  culture,  she  had 
excelled  all  her  contemporaries.  The  art  of  writing  had 
been  introduced  from  Phoenicia,  and  the  use  of  papyrus 
from  Egypt,  thereby  greatly  facilitating  the  recording  of 
facts  and  the  history  of  events  of  every  kind.  It  was  at 
this  auspicious  period  in  human  progress  that  Hippocrates, 
called  the  Great,  appeared  in  Greece.  He  was  born  in 
the  .(Esculapian  Temple,  on  the  Island  of  Cos,  about  460 
B.  C.  His  father,  Heraclides,  belonged  to  the  order 
yEsclepiadae,  and  is  represented  to  have  been  the  seven- 
teenth in  order  of  descent  from  ^sculapius.  His  mother, 
Phoenarete,  was  a  midwife,  eighteenth  in  descent  from 
Hercules. 

Hippocrates  received  his  early  education  under  his 
parents  in  the  Temple,  but  after  their  death  he  went  to 
Athens  and  made  himself  familiar  with  the  doctrines  of 
the  Sophists  under  Gorgias,  as  well  as  those  of  Pythagoras 
and  Democritus  and  their  antagonist,  Socrates.  Thus 
educated  in  the  best  schools  of  Greece,  and  thoroughly  ac- 
quainted with  whatever  records  relating  to  medical  topics 
had  accumulated  in  the  ^^sclepion  at  Cos,  which  was  one 
of  the  most  celebrated  then  in  existence,  he  commenced 
his  professional  career  contemporaneous  with  the  states- 
men Themistocles,  Miltiades,  Pericles  and  Xicias ;  the  phil- 
osophers, Anaxagoras,  Pythagoras,  Democritus,  Socrates 
and  Plato ;  the  dramatists,  ..^schylus,  Sophocles  and  Euri- 


21 

pides ;  the  orators   Lysias,  /Eschines   and   Demosthenes ; 
and  the  historians  Thucydides,  Herodotus  and  Zenophon. 

Although,  at  the  time  of  Hippocrates,  the  Greeks  had 
reached  the  cHmax  of  their  civilization,  their  medical  at- 
tainments and  practice  were  still  limited  mostly  to  the 
-^sculapian  Temples  with  their  ^sclepiadas,  and  the  few 
surgeons  attached  to  their  armies  and  gymnasiums  or  train- 
ing schools  for  the  athlete. 

But  the  fact  that  Hippocrates,  after  having  been  born 
and  educated  in  one  of  the  Temples,  had  visited  other 
cities  and  studied  thoroughly  the  doctrines  of  the  leading 
schools  of  philosophy,  had  prepared  him  for  a  wider  range 
of  mental  vision,  and  a  more  independent  application  of 
the  faculties  of  observation  and  reason  with  which  he 
appears  to  have  been  richly  endowed.  Consequently  we 
find  him  early  separating  himself  from  the  order  of  .^scle- 
piadae,in  which  he  had  been  born,  and  engaging  in  the  work 
of  a  general  practitioner  of  medicine.  As  such  he  visited 
and  practised  in  the  provinces  of  Thessaly,  Macedonia  and 
Scythia,  and  everywhere  studied  with  great  care  the  actual 
phenomena  of  diseases  and  their  causes.  After  spending 
several  years  in  this  somewhat  itinerant  mode  of  practice, 
during  which  he  gained  a  very  high  reputation  for  probity, 
learning  and  skill  he  settled  at  Larissa,  in  Thessaly,  where 
he  continued  to  practice  his  profession  until  his  death, 
about  377  B.  C.  This  would  make  the  duration  of  his 
life  about  eighty-three  years.  (I  use  the  word  of  indefinite 
meaning,  about,  advisedly,  for  the  reason  that  neither  his- 
torians nor  antiquarians  have  been  able  to  determine  pos- 
itively either  the  year  of  Hippocrates'  birth  or  death.) 
His  professional  services  were  solicited  by  all  classes  of 
the  people,  including  municipal  authorities  and  kings.  His 
reputation  is  said  to  have  been  greatly  increased  by  his 
successful  treatment  of  the  wife  of  the  philosopher,  Gor- 
gias ;  by  the  great  and  destructive  "plague"  that  prevailed  at 
Athens  between  430  B.  C.  and  425  B.  C. ;  and  the  cure  of 
Perdicas,  king  of  Macedonia,  who  was  sorely  afiflicted  with 
"lovesickness."  It  is  said  that  he  was  offered  a  large  sum 
of  money  by  the  Persian  king  Artaxerxes,  to  induce  him  to 


2.2 

become  the  chief  medical  advisor  of  the  king  and  his 
arm)\  But  he  patriotically  refused  to  bestow  his  profes- 
sional services  on  the  enemies  of  his  own  country. 

Hippocrates  was  a  patient  and  accurate  observer  and 
industrious  writer.  He  wrote  on  papyrus  and  in  the  Ionic 
dialect.  The  number  of  books  or  essays  bearing  his  name 
have  been  stated  by  different  writers  as  forty-two,  fifty- 
three  and  seventy-two.  Many  of  them,  however,  were 
doubtless  by  other  physicians  of  the  same  name,  of  whom 
there  were  no  less  than  five  later  in  the  same  family  line, 
and  some  of  them  are  plainly  fraudulent.  Only  nine  have 
been  unanimously  considered  genuine  works  of  Hippo- 
crates the  Great.  The  most  important  of  these  are  the 
Aphorisms ;  the  treatise  on  Air,  Water  and  Locality ;  and 
the  Essays  on  Prognostics,  Epidemics  and  Diet ;  all  of 
which  have  been  preserved  by  translation  and  republica- 
tion in  the  modern  languages  of  Europe,  including  the 
English. 

One   of  his  characteristic   precepts   is  worthy  of  the' 
attention  of  every  practitioner  of  medicine,  and  I  quote 
it  as  follows: 

"Life  is  short,  opportunity  fleeting,  judgment  difficult, 
treatment  easy,  thought  hard ;  but  treatment  after  thought 
is  proper  and  profitable". 

Equally  worthy  of  remembrance  are  the  following  max- 
ims :  "The  physician  is  a  servant,  not  a  teacher  of  nature". 
"Follow  nature".  "The  physician  should  benefit,  or  at 
least  not  injure".  Yet  he  declares  that,  "Timidity  indi- 
cates incapacity,  rashness  want  of  skill".  All  these  precepts 
clearly  point  towards  the  three  great  distinguishing  mental 
qualities  of  Hippocrates,  namely,  patient  observation,  log- 
ical reasoning  and  faithful  recording  of  both  facts  and 
deductions.  It  was  by  the  diligent  exercise  of  these  noble 
qualities  that  he  was  enabled  to  commence  an  absolutely 
new  era  in  medicine,  and  to  leave  a  literature  containing 
facts,  deductions,  and  practical  maxims  that  are  still,  after 
the  lapse  of  more  than  2,000  years,  worthy  of  our  careful 
study. 

Like  both  his  predecessors  and  contemporaries,  he  was 


23 

obliged  to  accept  as  cardinal  doctrines  the  assumptions  that 
fire,  air,  water  and  earth  were  the  real  elementary  forms 
of  matter  of  which  the  world  was  constituted ;  that  the  fire 
was  the  most  refined,  possessed  of  intelligence  and  identi- 
cal with  the  spirit  or  soul  of  man ;  and  that  the  four  fluids, 
blood,  phlegm,  bile  and  black  bile,  were  the  cardinal  hu- 
mors of  the  living  body. 

Unlike  them,  however,  instead  of  referring  all  dis- 
eases to  the  influence  of  good  or  evil  spirit — gods  or  god- 
desses— he  concentrated  his  attention  on  the  patient  study 
of  the  local  causes,  symptoms,  progress,  and  terminations 
of  diseases,  and  made  the  best  possible  use  of  the  four 
supposed  elements  and  four  fluids  to  explain  the  morbid 
processes  as  they  were  presented  for  his  study. 

From  such  study  he  soon  assumed  as  a  fundamental 
proposition  that  health  consisted  in  the  uniform  action 
and  reaction  of  all  these  elements  upon  and  between  them- 
selves ;  and  that  disease  was  an  irregular,  or  non-uniform, 
action  and  reaction  of  the  same  elements. 

He  further  assumed  that  heat  was  the  most  essential 
condition  of  life,  and  that  its  loss  was  the  cause  of  death. 
(This  assumption  was  revived  and  made  the  comer-stone 
of  the  Thomsonion  School  of  Medicine,  originating  in  the 
New  England  States  during  the  first  half  of  the  19th  cen- 
tury.) He  also  supposes  that  the  pneuma,  or  air,  circulat- 
ing in  the  vessels  to  be  a  second  force  essential  to  the  con- 
tinuance of  life,  and  that  its  irregular  circulation  is  a  cause 
of  disease.  These  two  forces,  heat  and  pneuma,  or  air, 
inherent  in  the  living  body  and  acting  in  conjunction  with 
the  other  elements,  appear  to  constitute  the  vis  vitse,  or  the 
Nature  on  which  Hippocrates  so  much  depends  for  the 
prevention  and  cure  of  disease.  By  strictly  clinical  ob- 
servation he  learned  that  these  forces,  constituting  Na- 
ture, were  sufficient  under  favorable  circumstances  to 
effect  the  cure  of  a  large  proportion  of  the  cases  of  disease. 
By  the  same  observations  he  learned  that  all  acute  dis- 
eases, especially,  progressed  through  a  succession  of  three 
stages  in  regular  order  and  within  limited  periods  of  time. 
These  stages  he  designated  as  of  crudity,  concoction  and  cri- 


24 

sis;  the  first  corresponding  with  our  prodrome  or  form- 
ing stage;  the  second  with  our  stage  of  active  develop- 
ment; and  the  third  with  our  stage  of  dechne.  And  as 
he  saw  in  most  cases,  at  the  crisis  marking  the  commence- 
ment of  dechne,  notable  evacuations  either  from  the  skin, 
kidneys  or  bowels,  these  were  regarded  as  the  morbid 
products  of  the  concoction  of  fluids  or  humors  during  the 
second  stage.  If  they  failed  to  appear  at  the  usual  period  it 
was  regarded  as  an  unfavorable  index  or  prognosis. 

Having  thus  determined  by  careful  clinical  observation, 
that  all  acute  diseases  inherently  tend  to  pass  through  the 
three  stages  named,  within  a  limited  period  of  time;  and 
when  they  do  so  with  regularity  to  end  in  recovery,  he 
logically  inferred  that  the  chief  object  of  treatment  was 
to  aid  the  natural  processes.  Hence  his  maxims,  already 
quoted,  to  "follow  Nature",  and  that  the  physician  is  the 
servant  or  pupil  and  not  the  teacher  of  nature.  By  true 
inductive  reasoning,  when  in  the  stage  of  concoction,  or 
what  we  call  the  stage  of  active  advancement,  the  heat 
became  too  intense,  he  endeavored  to  lessen  the  excess 
of  heat  by  cooling  drinks,  bathing,  and  sometimes  venesec- 
tion, and  a  restricted  diet ;  and  as  the  stage  of  crisis  ap- 
proached he  sought  to  aid  in  casting  out  the  products  of 
concoction  by  such  evacuants  as  diuretics,  diaphoretics, 
cathartics  and  sometimes  emetics. 

It  was  by  such  long-continued  observation,  and  the 
practice  of  as  rigid  a  system  of  inductive  reasoning  as  any 
advocated  by  Bacon  2,000  years  later,  that  Hippocrates  was 
enabled  to  deduce  those  practical  maxims  in  regard  to  the 
natural  stages  of  diseases,  and  the  therapeutic  indications 
afforded  by  them,  and  to  record  the  same  in  his  works  un- 
der the  head  of  Aphorisms,  Prognostics,  etc.,  and  which 
are  still  accepted  as  estabhshed  truths  in  therapeutics. 

Instead  of  following  the  example  of  all  his  predecessors, 
by  referring  the  causes  of  disease  to  supernatural  agen- 
cies, he  studied  with  the  same  diligence  and  mental  acumen 
the  influence  of  local  conditions  in  producing  disease,  as  is 
shown  in  his  work  on  ''Air,  Water  and  Locality",  and  on 
"Epidemics",  and  still  more  in  his  work  on  "Dietetics"  in 


which  he  discusses  the  influence  of  modes  of  Hving  and 
diet  in  both  sickness  and  health. 

The  writings  of  Hippocrates  show  that  he  was  a  gen- 
eral practitioner,  not  restricting  his  practice  to  one  or  two 
departments  of  the  healing  art. 

His  surgical  practice  was  not  extensive.  He  describes 
some  dislocations  and  fractures,  the  operations  of  tre- 
phining and  paracentesis  of  both  chest  and  abdomen,  and 
the  suppression  of  haemorrhage  by  cold  applications,  com- 
presses and  bandages.  But  he  remarks  that,  "he  who 
desires  to  practice  surgery  must  go  to  war". 

His  very  limited  knowledge  of  anatomy  and  physiology 
led  him  to  express  many  opinions  that  would  appear  very 
ludicrous  at  the  present  time.  For  instance,  he  makes  no 
distinction  between  vessels,  nerves  and  tendons,  but  re- 
gards the  two  last  as  carrying  air,  or  pneuma.  He  speaks 
of  the  food  as  "cooked  in  the  stomach  aided  by  heat  fur- 
nished by  the  liver".  The  brain  he  describes  as  a  secret- 
ing organ  condensing  into  mucus,  or  phlegm,  the  ascend- 
ing vapors  of  the  body  and  discharging  it  through  the 
nose.  And  he  ascribes  most  of  the  diseases  of  the  eyes 
to  the  descent  of  bad  humors  into  them  from  the  brain. 

Perhaps  the  best  English  translation  of  the  writings 
of  Hippocrates  is  by  Adams  in  two  volumes  published  in 
London,  1849. 

The  great  benefits  bestowed  upon  the  development  and 
progress  of  medicine  by  Hippocrates  were  threefold,  ist. 
He  effectually  severed  the  practice  of  medicine  from  sub- 
serviency to  the  priesthood,  and  gave  it  an  independent  pro- 
fessional standing.  2d.  He  boldly  substituted  a  thoroughly 
clinical  study  of  the  actual  symptoms,  progress  and  re- 
sults of  diseases  and  their  causes,  and  an  example  of 
strictly  inductive  reasoning,  for  the  purely  fanciful  or 
metaphysical  methods  of  all  his  predecessors.  3d.  By  a 
faithful  record  of  the  results  of  all  his  studies  in  such  lan- 
guage as  by  ready  translation  and  perpetuation  became 
the  actual  beginning  of  a  permanent  medical  literature. 
And  surely  these  are  sufficient  to  justify  his  being  called 
"The  Father  of  Rational  Medicine". 


26 

Notwithstanding  the  very  high  reputation  gained  by- 
Hippocrates  during  his  life,  he  left  no  pupils  or  followers 
imbued  with  the  same  spirit  of  investigation  as  himself. 
His  two  sons,  one  called  Thessalus  and  the  other  Draco, 
were  both  physicians ;  the  first  lived  and  practised  at  the 
court  of  Archelaus,  King  of  Macedonia,  and  the  second 
was  physician  to  Queen  Roxana.  His  son-in-law,  Polybus, 
is  credited  with  some  investigations  regarding  the  origin 
and  office  of  the  membrane  surrounding  the  egg,  and  with 
the  authorship  of  some  of  the  books  ascribed  to  Hippo- 
crates. But  neither  of  them  added  anything  to  the  progress 
of  medicine. 

The  individual  who  exerted  the  most  influence  directly 
following  Hippocrates  from  400  B.  C.  to  347  B.  C,  was 
Plato,  who  instead  of  following  the  rational  methods  of 
the  former,  endeavored  to  evolve  from  a  mixture  of  the 
philosophical  doctrines  of  Pythagoras  and  Socrates  a  dog- 
matic system  of  both  philosophy  and  medicine  as  fanci- 
ful as  any  that  preceded,  though  clothed  in  language  well 
calculated  to  captivate  his  pupils.  Having  resided  several 
years  at  Heliopolis,  he  became  familiar  w-ith  Egyptian 
mathematics. 

One  may  judge  of  the  value,  or  rather  the  non-value, 
of  his  philosophy  by  the  following :  "Absolute  intelligence, 
or  God  and  Matter,  constitute  the  universe.  The  world  is 
formed  of  the  four  elements  which  are  not  indivisible,  but 
composed  of  atoms ;  those  of  fire  being  pyramidal,  those 
of  earth  cubical,  those  of  air  octagonal,  and  those  of  water 
twenty-sided"  (Baas). 

His  medical  doctrines  were  of  the  same  dogmatic  fan- 
cies. Thus  he  teaches  that  continued  fever  is  caused  by 
fire ;  quotidian  by  air ;  tertian  by  water ;  and  quartan  by 
earth.  Of  course  medicine  derived  no  real  aid  from  him 
or  his  immediate  followers. 

Praxagoras,  of  Cos.  during  the  latter  part  of  the  third 
century  B.  C,  is  credited  with  having  discovered  the  dif- 
ference between  arteries  and  veins,  the  latter  always  car- 
r}-ing  blood,  while  the  former  he  said  carried  air  except  when 
wounded  so  as  to  allow  the  air  to  escape.     Then  they  be- 


27 

came  filled  with  blood  absorbed  from  adjacent  parts.  He 
also  studied  the  variations  of  the  pulse  in  health  and  dis- 
ease. 

The  most  influential  rnan  in  both  philosophy  and  med- 
icine during  the  third  century  B.  C.  was  Aristotle,  the 
teacher  of  Alexander  the  Great,  and  the  founder  of  the 
natural  sciences,  especially  botany,  zoology  and  compar- 
ative anatomy.  Being  the  intimate  friend  and  adviser  of 
the  Emperor  Alexander,  who  had  established  his  capital 
or  chief  city  at  Alexandria  in  Egypt,  he  received  from 
him  all  the  aid  he  needed  for  making  botanical  and  zoolog- 
ical collections,  and  prosecuting  the  dissection  of  animals. 
The  proceeds  of  his  labor  and  that  of  his  pupils,  were  ac- 
cumulated at  Alexandria  and  paved  the  way  for  the  estab- 
lishment of  the  great  Alexandrian  University  with  its  re- 
nowned library  and  museum. 

Although  by  the  actual  dissection  of  animals  Aristotle 
added  many  items  to  the  previous  knowledge  of  anatomy 
and  actually  remained  the  chief  authority  in  that  depart- 
ment for  eight  or  ten  centuries,  his  descriptions  were  very 
imperfect,  and  his  physiological  views  fanciful.  For  in- 
stance, with  reasonable  correctness  he  describes  the  brain 
as  composed  of  two  lobes  and  the  cerebellum  with  the 
ventricles,  but  fails  to  distinguish  between  nerves  and  ten- 
dons, and  thinks  both  are  derived  from  the  heart.  He 
clearly  recognized  four  general  functions  of  the  living  ani- 
mal body,  i.  e.,  the  nutritive,  the  sensitive,  the  motive  and 
the  intellectual.  The  three  first  he  regarded  as  common 
to  all  the  structures.  The  fourth,  intellect,  he  limits  to  a 
special  seat,  but  leaves  us  in  some  doubt  whether  he 
thought  that  seat  was  the  brain  or  the  heart. 

Alexander,  who,  with  his  victorious  army,  had  sub- 
dued all  Greece,  Egypt,  and  nearly  all  of  the  southwestern 
part  of  Asia,  founded  n6ar  the  mouth  of  the  Nile  the  city 
of  Alexandria  as  the  capital  of  his  vast  empire,  and  with 
the  aid  of  Aristotle  and  Plato  had  also  made  it  the  chief 
center  of  learning,  died  at  the  early  age  of  thirty-three. 
Directly  after  his  death  the  empire  was  divided  between 
two  or  three  of  his  most  successful  generals.     The  King- 


28 

dom  of  Egypt  with  its  new  capital  city  came  under  the 
rule  of  Ptolemy  Sotor,  who  was  followed  in  succession  by 
Ptolemy  Pliiladelphus  and  Ptolemy  Euergetes,  covering  a 
period  of  lOO  years,  or  from  323  B.  C.  to  222  B.  C.  All 
these  followed  the  example  of  Alexander  in  extending 
the  most  liberal  aid  to  those  engaged  in  cultivating 
science,  literature  and  the  arts,  and  succeeded  in  elevating 
Alexandria  to  the  zenith  of  its  greatness,  as  the  emporium 
of  commerce,  literature,  science  and  art.  During  their  reign 
their  Greco-Egyptian  Kingdom  was  supposed  to  contain 
30,000  towns  and  more  than  7,000,000  of  inhabitants.  It 
is  claimed  that  the  great  library  contained  700,000  volumes, 
which  means  that  number  of  rolls  of  papyrus,  a  dozen  of 
which  might  not  contain  as  many  words  as  one  of  our  octavo 
volumes  of  250  printed  pages.  The  museum  contained  a 
proportionately  vast  collection  of  works  of  art  and  spec- 
imens of  natural  history,  particularly  in  botany,  zoology 
and  comparative  anatomy,  to  which  was  added  at  least  one 
human  skeleton.  The  great  library  and  museum  consti- 
tuted the  basis  of  the  Alexandrian  University,  which  at- 
tracted not  only  students  of  every  kind,  but  also  the 
learned  in  all  departments  of  human  knowledge  from  all 
the  surrounding  countries.  It  is  well  to  remember,  how- 
ever, that  it  was  to  the  philosopher  and  physician,  Aris- 
totle, that  Alexander  owed  the  accomplishment  of  the 
greater  part  of  his  literary  and  scientific  works;  and  that 
the  Ptolemies  were  equally  indebted  to  the  physicians 
Herophilus  and  Erasistratus  and  their  disciples. 

Herophilus  was  born  in  Chalcedon  about  335  B.  C, 
became  a  pupil  of  Praxagoras,  of  Cos,  from  whom  he  im- 
bibed an  earnest  desire  to  prosecute  the  study  of  human 
anatomy,  and  was  the  ordinary  physician  to  Ptolemy  Sotor 
when  he  succeeded  Alexander  as  King  of  Egypt.  Not- 
withstanding the  universal  prejudice  and  extreme  penal- 
ties against  all  efiforts  to  dissect  the  human  body,  Hero- 
philus obtained  the  King's  permission  to  secretly  dissect 
the  body  of  one  or  more  criminals  after  death.  It  was 
doubtless  from  this  source  the  complete  human  skeleton 
came  into  the  Alexandrian  Museum,  and  which  remained 


29 

for  several  centuries  one  of  the  chief  attractions  for  stu- 
dents and  practitioners  of  medicine.  By  the  opportunity 
thus  afforded  he  gained  a  much  better  knowledge  of  the 
different  parts  of  the  body,  describing  with  considerable 
accuracy  the  brain  and  nerves  and  the  connection  of  the 
latter  with  the  former,  and  also  their  sensory  and  motor 
functions.  He  described  the  pulmonary  artery  and  vein; 
the  lymphatic  and  chyliferous  vessels ;  together  with  most 
of  the  viscera  of  the  abdomen.  In  diagnosis,  prognosis 
and  treatment  of  diseases  he  followed  Hippocrates  more 
closely  than  any  of  his  contemporaries. 

Erasistratus,  of  lulls,  who  followed  Herophilus  only 
twenty-three  years  later,  was  a  pupil  of  Chrysippus,  of 
Cnidos,  and  of  Theophrastus,  and  soon  became  the  ordi- 
nary physician  of  King  Seleucus.  Antiochus,  the  son  of 
Seleucus,  had  been  sick  through  ardent  love  for  his  step- 
mother. Erasistratus  correctly  diagnosed  his  case  by  tak- 
ing notice  of  his  palpitation,  trembling  and  blushing  on 
the  approach  of  the  lady,  and  cured  him  by  prescribing 
their  marriage.  For  this  he  gained  not  only  a  high  repu- 
tation for  skill  in  diagnosis,  but  also  a  large  fee,  said  to 
have  been  one  hundred  talents.  Subsequently,  he  resided 
in  Alexandria  where  he  became  the  physician  and  com- 
panion of  Ptolemy  Philadelphus  as  Herophilus  had  been 
of  Ptolemy  Sotor. 

Pergamos  was  the  capital  city  of  another  Kingdom, 
resulting  from  the  division  of  the  Empire  of  Alexander,  and 
the  seat  of  a  noted  .^sclepion.  For  many  years  she  main- 
tained an  active  rivalry  with  Alexandria,  especially  as  a 
seat  of  learning  and  possessed  of  a  library  of  many  thou- 
sand volumes  founded  by  Eumenes  H,  about  170  B.  C.  On 
account  of  this  rivalry  the  second  Ptolemy  thought  to  crip- 
ple the  work  at  Pergamos  by  prohibiting  the  exportation 
of  papyrus  from  Egypt.  But  that  only  resulted  in  the  dis- 
covery and  use  of  parchment  instead  of  papyrus  at  Perga- 
mos. 

Mithridates,  both  king  and  physician,  established  ex- 
tensive botanical  gardens  at  Pergamos  and  cultivated  many 
medicinal  and  poisonous     plants  with     which  he  experi- 


30 

mented  both  on  himself  and  others  for  the  purpose  of  dis- 
covering an  antidote  that  by  use  would  render  him  im- 
mune to  all  poisons ;  for  he,  like  many  of  the  rulers  or 
kings  of  that  period,  lived  in  constant  fear  of  being  pois- 
oned by  his  enemies.  The  so-called  antidote  formed  by 
him,  contained  a  large  number  of  ingredients,  and  under 
the  name  "Mythridaticum",  retained  a  high  reputation 
through  many  centuries. 

Aside  from  the  works  of  Aristotle,  Herophilus  and 
Erasistratus,  real  medicine  made  very  little  progress  in 
the  great  Alexandrian  School  until  the  city  and  the  whole 
Greco-Egyptian  kingdom  fell  a  prey  to  the  victorious  Ro- 
man armies  under  Tertullus  and  Pompey.  Until  the  time 
of  this  conquest  the  Romans  had  made  very  little  progress 
m  any  department  of  the  healing  art.  What  rudimentary 
efforts  were  made  in  the  practice  of  either  medicine  or 
surgery  were  confined  mostly  to  their  slaves  and  conse- 
quently medicine  was  in  bad  social  repute.  But  in  ac- 
cordance with  the  practice  of  all  the  conquerors  of  their 
time,  the  Roman  legions  took  as  legitimate  booty  all  the 
movable  works  of  art  and  other  treasures  from  the  con- 
quered countries  to  Rome.  In  doing  this,  they  also  took 
many  Greeks  for  servants,  and  among  them  some  who 
proved  much  more  skilful  in  medicine  and  midwifery  than 
any  of  their  own  countrymen.  Not  only  this,  but  as  soon 
as  it  became  manifest  that  the  future  metropolis  of  learn- 
ing, as  well  as  of  commerce,  was  to  be  Rome  instead  of 
Alexandria,  the  most  learned  in  art,  philosophy  and  medi- 
cine began  to  migrate  thither  from  all  the  other  countries, 
as  they  had  previously  been  doing  to  the  Alexandrian  Uni- 
versity. By  such  transference,  in  a  comparatively  brief 
period  of  time,  the  Greek  culture  had  made  as  complete 
a  conquest  of  the  Roman,  as  the  Roman  armies  had  those 
of  Greece. 

The  earliest  physician  to  gain  renown  in  Rome  was 
Asclepiades,  born  in  Prusa  in  Bithynia,  128  B.  C.  He  was 
educated  at  Alexandria,  and  of  course  was  familiar  with 
the  schools  of  philosophy  that  had  flourished  in  Greece. 
He  spent  a  few  years  practicing  medicine  in  Athens,  Pro- 


31 

pontis  and  on  the  Hellespont,  and  then  went  to  Rome. 
At  Rome  he  first  taught  rhetoric,  but  soon  resumed  the 
practice  of  medicine  and  by  his  superior  mental  endow- 
ments, coupled  with  an  abundance  of  self-assurance,  he  be- 
came the  personal  friend  of  Cicero,  Crassus  and  other  influ- 
ential Romans,  and  gained  a  very  high  reputation. 

His  reputation  was  caused  more  by  the  vehemence  of 
his  denunciation  of  Hippocrates  and  the  advocates  of  the 
humoral  doctrines  founded  on  the  four  humors,  than  by 
anything  that  he  added  to  the  general  stock  of  medical 
knowledge.  For  his  own  doctrines  were  only  slight  mod- 
ifications of  those  of  Heraclides,  Democritus  and  Epicurus, 
relating  to  atoms,  promulgated  three  or  four  centuries 
earlier.  He  regarded  all  bodies  as  composed  of  very  nu- 
merous and  minute  atoms  between  which  were  empty 
spaces  or  pores.  "If  the  motion  of  these  particles  is  quiet 
and  regular  it  is  called  health,  but  if  it  is  irregular,  feeble 
or  boisterous,  sickness  arises.  Sickness  also  originates  in 
the  air  received  in  respiration,  and  in  the  food,  and  enters 
our  bodies  in  respiration  and  digestion,  by  both  of  which 
it  passes  through  the  pores  into  the  heart  and  the  blood, 
and  through  this  finally  into  the  whole  body  which  it  nour- 
ishes. The  pulse  originates  in  an  influx  of  the  particles 
into  the  .vessels ;  animal  heat,  sensation,  secretion,  in  a 
similar  way ;  hunger  and  thirst,  however,  originate  in 
emptiness  of  the  pores  of  the  stomach,  which,  in  accordance 
with  our  varying  conditions,  may  be  either  full,  empty  or 
contracted". — ( Baas. ) 

Such  were  the  anatomico-physiological  ideas  of  Ascle- 
piades,  the  founder  of  the  Roman  Medico-Philosophical 
school  called  Methodists,  or  Solidists,  which  constituted 
the  first  serious  opposition  to  the  humoral  doctrines  of 
all  the  preceding  ages.  He  gained  some  surgical  reputa- 
tion by  performing  tracheotomy  for  the  relief  of  severe 
cases  of  angina.  In  the  general  treatment  of  disease  he 
was  conservative,  relying  much  on  the  regulation  of  diet, 
cooling  drinks,  frequent  bathing  and  friction  or  massage, 
but  he  sometimes  resorted  to  enemas,  cathartics,  emetics, 
and  blood-letting. 


32 

Among  the  most  prominent  disciples  of  Asclepiades 
was  Themison,  of  Laodicea,  50  B.  C.  The  distinctive  fea- 
ture of  his  teaching  was  not  that  the  body  was  made  of 
atoms  and  pores  simply,  but  that  the  pores  were  capable 
of  expanding  and  contracting;  and  he  attributed  all  dis- 
eases to  a  want  of  harmony  between  the  size  of  the  atoms 
and  pores.  Hence  he  arranged  all  diseases  into  three 
classes:  ist.  Those  that  caused  too  great  relaxation  of 
the  pores,  called  Laxta;  2d.  Those  caused  by  constriction 
of  pores,  called  Stricta;  and  3d.  Those  with  some  pores  re- 
laxed and  others  contracted,  called  Mixta. 

A  much  more  important  practitioner  and  contributor 
to  medical  literature  was  Soranus,  of  Ephesus,  who  prac- 
tised in  Rome  during  the  times  of  Trajan  and  Hadrian 
from  98  A.  D.  to  138  A.  D.  He  wrote  very  creditable 
works  on  medicine,  surgery,  midwifery,  diseases  of  wo- 
men, and  on  the  etymology  of  the  names  of  the  different 
parts  of  the  human  body.  His  work  on  midwifery  was 
for  the  instruction  of  midwifes,  translations  of  which  have 
been  preserved,  and  show  that  practical  obstetrics  was  at 
that  time  relatively  better  understood  than  any  other 
branch  of  medicine.  He  wrote  in  the  Greek  language, 
but  several  of  his  works  were  subsequently  translated  into 
the  Latin. 

Aulus  Cornelius  Celsus,  from  25  B.  C.  to  45  A.  D.,  was 
another  important  Roman  medical  writer  of  high  author- 
ity. He  wrote  in  the  Latin  language,  and  in  a  style  so 
pure  and  elegant  that  he  has  been  called  the  Cicero  of 
medicine.  He  also  wrote  works  on  philosophy,  oratory, 
jurisprudence  and  history.  His  medical  writings  are  not 
so  valuable  for  the  original  matter  they  contain,  as  for 
their  full  summary  of  the  views  of  the  best  authors  during 
the  later  Greek  and  Alexandrian  periods,  which  would 
have  been  otherwise  lost. 

Soon  after  Celsus  and  Soranus,  the  disciples  of  the  school 
of  Methodism  became  divided  into  several  minor  schools, 
of  which  only  the  Pneumatic  and  Eclectic  are  worthy  of 
mention.  The  most  important  feature  of  the  doctrines  of 
the  Pneumatic  school,  was  the  engrafting  of  the  pneuma, 


-^ 


33 

or  world-soul  of  Zeno,  upon  the  naked  SoHdism  of  the 
Methodists;  and  its  most  prominent  supporter  was  Athe- 
naeus,  of  AttaHa,  in  Cihcia. 

The  founder  of  the  Eclectic  school  was  Agathinus,  of 
Sparta,  about   90  A.    D.     His  cardinal   principle   was   to 
avoid  theories  and  metaphysical  speculations,  and  to  se- 
lect from  all  the  preceding  schools  or  teachings,  that  which 
was  most  reasonable  and  practically  beneficial.       Among 
his   influential ,  followers    were    Archigenes    of    Apamea ; 
Aretjeus,  of  Cappadocia;  Herodotus;  Philip,  of  Caesarea; 
and  more  important  than  all  the  others  Claudius  Galen,  of 
Pergamos,  during  the  last  half  of  the  second  century,  A.  D. 
It  has  already  been  stated  that  prior  to  the  conquest 
of  Greece  the  Romans  had  no  medicine  worthy   of   the 
name,  and  that  the  few  who  made  some  efforts  to  practise 
belonged  to  a  class  of  servants  or  slaves,  but  we  have 
seen  that  in   Greece,   Egypt  and  the  countries  of  Asia, 
their  practice  of  medicine  was  so  closely  connected  with 
their  religion,  that  its  practitioners  were  directly  affiliated 
with  priests,  kings  and  even  deities,  and  consequently  they 
occupied  a  very  high  social  position.     At  first,  the  intro- 
duction of  Greek  medical  practice  into  Rome  was  met 
with  bitter  opposition  and  scorn.     But  when  Asclepiades 
had  gained  the  personal  friendship  of  Cicero  and  accom- 
panied Csesar  in  one  of  his  campaigns  where  he  had  an 
opportunity  to  show  his  superior  knowledge  and  skill,  the 
Emperor  was  soon  induced  to  grant  the  privileges  of  citi- 
zenship to  all  physicians  in  Rome.     Later  the  Emperor 
created  court-physicians,  as  well  as  city  and  district  phy- 
sicians, called  Archiatri,  with  fairly  liberal  salaries;  and 
the  profession  gained  a  fair  standing  among  the  Romans. 
But  much  the  larger  number  of  those  who  gained  a 
high  rank  were  either  Greeks,  Egyptians  or  Hebrews,  and 
most  of  the  minor  surgery  and  midwifery   remained   in 
the  hands  of  barbers  and  female  slaves. 


34 


CHAPTER  III. 

HISTORY  OF  MEDICINE  FROM  THE  TIME  OF  GALEN,    I3I   A.  D., 
TO  THE  END  OF  THE  SEVENTH  CENTURY,  A.  D. 

Claudius  Galen  was  born  at  Pergamos  131  A.  D.,  and  is 
reported  to  have  died  204  A.  D.,  aged  about  seventy-three 
years.  He  was  the  son  of  Nicon,  an  architect,  by  whom  he 
was  educated  until  he  attained  the  age  of  fifteen  years.  He 
then  commenced  the  study  of  the  prevailing  systems  of  philos- 
ophy and  of  medicine,  first  at  Pergamos  and  subsequently 
at  Corinth,  At  the  age  of  twenty-one  years  he  went  to 
Smyrna,  and  after  visiting  the  most  interesting  places  in 
Asia  Minor  and  Palestine,  he  went  to  Alexandria  and  spent 
considerable  time  in  the  great  Librar}^  and  Museum,  and 
was  much  interested  in  the  study  of  the  complete  human 
skeleton  contained  in  the  latter.  Having  acquired  a  thor- 
ough knowledge  of  the  works  of  the  most  celebrated  phy- 
sicians and  philosophers  from  the  time  of  Hippocrates  to  his 
own  day,  he  returned,  at  the  age  of  twenty-eight  years,  to 
his  native  city,  Pergamos,  and  engaged  in  the  practice  of 
medicine  in  connection  with  the  gymnasium,  and  rapidly  ac- 
quired a  high  reputation. 

Six  years  later  he  changed  his  residence  to  Rome,  where 
he  not  only  engaged  in  general  practice,  but  also  in  lecturing 
on  anatomy  and  physiology,  and  by  his  unusual  attainments 
and  industry  he  soon  attracted  general  attention.  But  the 
indulgence  of  an  inordinate  self-complacency  in  criticising 
freelv  all  his  contemporaries  and  nearly  all  the  schools  of 
philosophy  and  medicine  that  had  prevailed  before  his  day, 
caused  him  to  be  involved  in  bitter  controversies  and  to  be- 
come so  filled  with  disgust  that  in  a  few  years  he  abandoned 
Rome  and  returned  to  Pergamos.  One  year  later,  however, 
he  was  induced  by  the  Emperor,  Marcus  Aurelius,  to  again 
visit  Rome,  where  he  became  Physician-in-Ordinar}-  to  the 
ruler  Commodus,  and  continued  there  until  the  end  of  his 
life ;  which  has  been  stated  by  different  authors  as  occurring 
in  200,  202,  204  and  206,  A.  D. 


35 

He  was  a  very  industrious  student  and  prolific  writer  on 
a  wide  range  of  subjects.  His  works  on  grammatical,  math- 
ematical, philosophical  and  legal  subjects  numbered  one 
hundred  and  twenty-five.  His  independent  works  on  medi- 
cine were  eighty-three ;  and  his  Commentaries  on  the  works 
of  Hippocrates  were  fifteen,  beside  which  he  left  a  large 
amount  of  unpublished  manuscript. 

His  treatises  on  medical  subjects,  called  "Canonical"  be- 
cause they  remained  the  chief  medical  text-books  through 
the  Middle  Ages, or  more  than  i,ooo  years,  were  his  "De  Usu 
Partium  Corporis  Humani";  "De  Pulsibus";  "Ars  Parva"; 
"Methodus  Modendi" ;  "De  Crisibus" ;  "De  Differentiis  Feb- 
rium";  and  his  Commentaries  on  Hippocrates.  While  he 
criticised  freely  the  views  of  his  predecessors,  and  denied  af- 
filiation with  any  preceding  school,  he  nevertheless  adopted 
nearly  all  the  leading  doctrines  of  Hippocrates  and  endeav- 
ored to  construct  upon  them  a  more  complete  system  of  ec- 
lectic practice  than  that  of  Agathinus  and  Aretius,  which  he 
had  freely  denounced.  The  four  elements,  fire,  air,  water 
and  earth,  and  the  four  cardinal  humors,  phlegm,  blood,  bile 
and  atrabile,  with  the  pneuma,  or  spiritus-vitalis,  constitute 
the  basis  of  all  his  doctrines,  as  they  had  of  all  his  prede- 
cessors, except  perhaps  Asclepiades  and  his  direct  disciples. 
This  could  not  be  otherwise,  so  long  as  there  was  no  science 
of  chemistry  by  which  the  real  elementary  composition  of 
bodies  could  be  determined  and  the  relations  of  such  ele- 
ments to  each  other.  Yet  Galen  assumed  that  the  spiritus- 
vitalis,  or  pneuma,  was  the  primitive  vitalizing  force  or  soul, 
received  through  respiration  and  by  penetrating  everv^  part 
of  the  body  developed  three  general  faculties  designated  as 
"animal",  "vital"  and  "natural",  and  four  special  faculties 
or  functions  termed  "attraction",  "propulsion",  "retension" 
and  "secretion".  To  these  special  faculties,  acting  in  differ- 
ent organs  and  structures,  he  attributed  the  processes  of  as- 
similation, nutrition,  secretion  and  muscular  movements. 
\Mien  the  several  humors  and  all  these  faculties  or  func- 
tions were  in  their  natural  condition  it  constituted  health. 
Their  disturbance  or  want  of  harmony  constituted  disease. 
He  classified  diseases  under  two  heads,  general  and  local. 


36 

The  general  diseases  he  attributed  to  disorder  of  the  car- 
dinal humors,  and  local  diseases  to  disturbance  of  one  or 
more  of  the  special  functions  or  faculties.  He  assumed  that 
all  general  fevers  were  caused  by  concoction  or  putridity  of 
the  humors,  even  specifying  that  quotidians  were  caused  by 
disorder  of  the  phlegm,  tertians  by  the  yellow  bile,  and  the 
quartans  by  the  black  bile.  He  also  recognized  the  division 
of  causes  of  disease  into  two  classes,  i.  e.,  predisposing  and 
exciting.  And  in  his  general  anatomical  and  physiological 
views  he,  more  distinctly  than  any  previous  writer,  recog- 
nized the  human  body  as  the  work  or  product  of  an  intelli- 
gent, supreme  or  final  cause,  by  which  all  its  parts  had  been 
adjusted  in  harmony  with  a  definite  plan. 

But  the  most  important  additions  to  our  knowledge  of 
real  value,  made  by  Galen,  were  in  the  departments  of  an- 
atomy and  physiolog}'.  Having  gained  a  fair  knowledge  of 
the  bones  of  the  human  skeleton  by  their  study  in  the  Alex- 
andrian jNIuseum,  he  recognized  distinctly  the  cavities  of 
the  head,  chest  and  abdomen,  and  by  the  dissection  of  ani- 
mals was  enabled  to  give  a  better  description  of  the  contents 
•of  each  cavity  than  any  of  his  predecessors.  By  such  dissec- 
tions he  was  enabled  to  give  fairly  correct  descriptions  of 
many  of  the  muscles  of  the  upper  and  lower  extremities  and 
of  the  neck.  He  distinguished  the  nerves  from  tendons  and 
traced  many  of  them  to  their  origin  from  the  brain  and  spinal 
cord ;  and  by  intelligent  vivisections  he  demonstrated  both 
the  contraction  of  muscles  and  the  motor  function  of  certain 
nerves.  He  represented  the  motor  nerves  as  hard  and  orig- 
inating from  the  spinal  cord,  and  the  sensory  nerves  as  soft 
and  originating  from  the  brain.  The  lachrymal  glands  with 
their  ducts  were  discovered,  and  their  secretion  of  tears  de- 
scribed by  him,  such  secretion  having  been  previously  con- 
sidered to  be  an  exudation  from  the  aqueous  humor  of  the 
eye. 

Galen  clearly  described  the  three  coats  of  the  arteries  and 
their  connection  with  the  heart,  but  still  taught  that  they 
carried  the  pneuma  or  vital  spirits,  while  he  thought  the 
veins  originated  from  the  liver  and  carried  the  blood  con- 
cerned in  nutrition.    He  states  correctly  that  respiration  is 


37 

effected  by  the  action  of  the  intercostal  muscles  and  dia- 
phragm, but  claims  that  the  air,  or  pneuma,  not  only  fills 
the  lungs  but  also  passes  into  the  heart  and  arteries.  He  rep- 
resents the  food  taken  into  the  stomach  as  passing  from 
thence  into  the  liver,  where  it  becomes  converted  into  blood 
and  is  then  passed  on  into  the  right  cavities  of  the  heart, 
from  which  it  is  returned  through  the  veins  to  all  parts  of 
the  system  and  mostly  used  in  the  nutrition  of  the  various 
structures.  He  devoted  much  time  to  the  study  of  the  pulse 
and  its  variations  in  health  and  disease,  and  wrote  several 
papers  concerning  it.  He  also  took  note  of  the  pulsating 
movements  of  the  brain,  which  he  regarded  as  the  seat  of  the 
rational  soul,  while  courage  and  the  passions  he  located  in 
the  heart.  In  the  domain  of  pathology  he  followed  closely 
the  views  of  Hippocrates  both  as  regards  the  concoction  of 
humors  and  the  observance  of  critical  days,  or  crises.  He 
also  recognized  the  tendency  of  acute  general  diseases  to 
pass  through  successive  stages,  which  he  designated  as  the 
stadium  initiale,  incrementi,  acmes  and  decrementi.  These 
fairly  represent  the  forming  stage,  the  stage  of  increase,  the 
climax  and  the  stage  of  decline  of  modern  writers.  In  the 
direct  treatment  of  the  sick,  Galen  followed  closely  in  the 
footsteps  of  Hippocrates. 

A  more  independent  investigator  and  writer  on  the  ma- 
teria medica  of  that  time  was  Padanius  Dioscorides,  of  An- 
asarba,  and  later,  of  Csesarea,  in  Cilicia.  He  visited  most  of 
the  countries  in  the  southern  part  of  Europe  and  wrote  a 
work  on  Materia  Medica  that  was  retained  as  the  chief  au- 
thority or  text-book  in  that  department  for  1,400  years.  The 
time  covered  by  Dioscorides  and  Galen  was  that  during 
which  the  Christian  religion  as  proclaimed  by  Christ  and  his 
Apostles  was  being  actively  advocated  not  only  in  Palestine, 
but  throughout  the  greater  part  of  the  Roman  Empire.  The 
zealous  advocacy  of  the  Jewish  doctrine  of  one  God  as  the 
maker  and  upholder  of  the  universe,  and  one  mediator  be- 
tween'God  and  man,  with  the  denunciation  of  the  worship  of 
all  other  Gods  and  Goddesses  as  idolatry,  necessarily  brought 
the  converts  of  the  newly  proclaimed  Christianity  in  direct 
antagonism  to  the  various  contemporary  schools  of  philoso- 


38 

phy,  and  still  more  so  with  the  methods  of  treating  the  sick 
at  the  various  /Esclepiadse,  or  so-called  schools  of  medicine. 
The  result  of  this  conflict  was  little  or  no  real  progress  in 
any  department  of  medicine  during  the  third,  fourth  and  the 
first  half  of  the  fifth  centuries  of  the  Christian  Era. 

Constantine  I.  was  the  first  of  the  Roman  Emperors  to 
embrace  the  Christian  religion,  and  he  commenced  his  reign 
during  the  last  quarter  of  the  third  century  A.  D,  In  312 
A.  D.  he  proclaimed  at  Rome  absolute  free  toleration  in  re- 
ligion. In  330  A.  D.  he  removed  his  seat  of  government  to 
Byzantium,  which  subsequently  took  the  name  of  Constan- 
tinople, where  the  Emperor  died  in  337  A.  D. 

The  great  museum  at  Alexandria  which  had  so  long  at- 
tracted the  students  and  professional  men  of  all  the  sur- 
rounding countries  was  first  burned  by  one  of  the  ships  of 
Cffisar's  fleet  during  a  Roman  invasion  in  47  B.  C.  It  was 
subsequently  restored  to  a  very  great  extent  by  Cleopatra, 
but  was  finally  utterly  destroyed  by  fire  during  a  domestic 
revolt  in  265  A.  D.  The  great  Alexandrian  library  was  like- 
wise burned,  but  not  until  an  invasion  of  the  Saracens  in 
640  A.  D. 

Fortunately  for  the  preservation  of  the  medical  works  of 
greatest  value  from  the  time  of  Hippocrates  to  Galen,  Ori- 
basius,  of  Pergamos,  who  was  born  326  A.  D.,  liberally  ed- 
ucated generally,  and  specially  in  medicine  at  Alexandria 
under  Zeno,  became  the  personal  friend  and  physician  to  the 
Emperor  Julian,  called  the  Apostate.  He  was  appointed  by 
the  Emperor,  Quaestor  of  Constantinople,  and  was  requested 
to  make  a  fair  compilation  of  all  the  valuable  medical  works 
that  had  been  written  from  the  time  of  Hippocrates  to  Galen. 
Oribasius  was  well  qualified  for  the  task  and  completed  it  so 
far  as  to  make  a  series  of  seventy  books  in  the  Greek  lan- 
guage, in  which  were  included  works  of  Hippocrates,  Eras- 
istratus,  Soranus,  Archigenes,  Dioscorides,  Galen  and  many 
others.  Some  of  his  collations  were  accompanied  by  useful 
comments,  and  he  is  credited  for  good  descriptions  of  both 
syphilis  and  gonorrhoea,  and  with  being  the  first  to  recom- 
mend'the  use  of  urethral  and  vaginal  injections  in  the  treat- 
ment of  the  last  named  disease.    As  this  was  more  than  1,000 


39 

years  before  the  discovery  of  America  by  Columbus,  it  af- 
fords very  good  evidence  that  neither  of  those  diseases  were 
imported  into  Europe  from  America,  as  has  been  claimed  by 
some  more  modern  writers. 

The  medical  writings  of  Oribasius  furnished  but  little 
that  was  new  or  original  in  any  of  the  departments,  but  was 
of  very  great  value  in  preserving  the  most  important  part 
of  tlie  works  of  the  early  Greek  and  Roman  authors  in  such 
form  as  to  be  transmitted  to  subsequent  generations.  And 
an  excellent  edition  of  his  works  was  translated  into  French 
and  published  in  Paris,  in  four  volumes,  by  Bussemaker  and 
Daremberg  in  1851-62.' 

After  the  death  of  the  Emperor  Julian,  to  whose  fortunes 
Oribasius  had  closely  adhered,  he  was  persecuted  and  ban- 
ished from  Rome  to  a  country  of  barbarians.  But  he  con- 
tinued his  writing  and  medical  practice  with  such  success 
that  in  a  few  years  he  was  recalled  and  reinstated  not  only 
in  favor,  but  was  also  recompensed  for  his  losses,  and  re- 
tained a  high  reputation  until  his  death,  403  A.  D. 

Cselius  Aurelianus,  a  native  of  Sicca,  in  Numidia,  was  a 
teacher  and  practitioner  of  medicine  in  Rome  during  the 
last  part  of  the  fourth  and  beginning  of  the  fifth  centuries 
A.  D,  He  wrote  voluminous  works  on  materia  medica, 
"Chronic  Diseases"  and  on  "Diseases  of  Women",  consist- 
ing largely  of  translations  of  the  writings  of  Soranus  of 
Ephesus.  He  i&  credited  with  having  given  a  good  descrip- 
tion of  gout  and  its  treatment,  and  with  having  insisted 
upon  the  correct  therapeutic  principle  that  it  was  far  more 
important  to  prevent  the  recurrence  of  the  paroxysms  than 
to  combat  the  paroxysm  itself.  He  advocated  the  condensa- 
tion of  milk,  and  the  use  of  lime  to  prevent  its  coagulation. 
He  improved  the  methods  of  differential  diagnosis  in  regard 
to  several  diseases  and  even  hinted  at  the  practice  of  auscul- 
tation. He  also  opposed  the  resort  to  physical  restraint  and 
advocated  seclusion  in  the  management  of  nervous  and 
mental  diseases.  His  works  gained  a  high  degree  of  popu- 
larity and  remained  much  in  use  during  the  six  or  seven 
succeeding  centuries. 

The  great  Roman  Empire  having  been  formally  divided 


%f 


40 

into  Eastern  and  Western  Empires  in  395  A.  D.,  the  Western 
rapidly  declined  in  power,  population  and  influence  under  the 
repeated  invasions  of  the  more  barbarous  peoples  from  the 
north,  and  the  Eastern  Empire,  with  Byzantium  (Constan- 
tinople) for  its  seat  of  government,  became  relatively  more 
important  and  more  attractive  for  physicians  and  educated 
men  generally.  Consequently  during  the  first  half  of  the 
sixth  century,  during  the  reign  of  Justinian  I.,  we  find 
^tius  occupying  much  the  same  relative  position  in  that  city 
as  had  been  occupied  at  Rome  by  Oribasius  and  Cselius 
Aurelianus.  ^tius  was  born  in  Mesopotamia,  502  A.  D., 
educated  in  medicine  at  Alexandria,  but  he  returned  to  By- 
zantium to  practise  his  profession,  where  he  gained  a  high 
T  X  reputation  and  lived  until  575  A.  D.  He  embraced  the  doc- 
"  V*"^  trines  of  the  Christian  religion  and  was  physician  in  ordinary 
to  the  Emperor  Justinian  I.,  wdio  endeavored  to  close  or  ban- 
ish all  so-called  pagan  schools  throughout  the  Eastern  Em- 
pire .  He  devoted  much  time  to  the  compilation  of  what- 
ever he  found  valuable  or  remarkable  in  the  writings  of  his 
predecessors,  whether  Egyptian,  Greek  or  Roman.  In  doing 
this  he  produced  sixteen  books  or  "Sermones"  on  different 
medical  subjects,  the  whole  constituting  a  text-book  of  gen- 
eral medicine  and  surgery,  in  which  he  preserved  the  most 
valuable  part  of  the  works  of  Archigenes,  Leonides,  Soranus, 
Aspasia  and  many  others  that  would  have  been  otherwise 
lost.  A  Latin  translation  of  his  whole  work  was  published 
in  the  sixteenth  century  (Basil.  1533-35).  He  was,  how- 
ever, not  a  compiler  merely,  but  added  many  observations  of 
value  in  both  surgery  and  practical  medicine.  He  recom- 
mends the  use  of  many  salves  and  plasters  in  the  dressing 
of  wounds ;  the  irrigation  of  wounds  with  cold  water,  and 
the  suppression  of  haemorrhage  by  litigation  and  torsion. 
He  also  mentions  the  use  of  setons  and  the  practice  of  lith- 
otomy. He  practised  free  venesection  in  the  treatment  of 
cerebral  congestion  and  active  inflammation,  and  recom- 
mends a  decoction  of  pimperel  (Anagallis  Phoenicea)  for 
hydrophobia  and  of  pomegranate  for  the  expulsion  of 
worms.    He  mentions  the  prevalence  of  a  disease  of  children, 


41 

evidently  the  same  as  now  called  diphtheria,  and  noticed  the 
occasional  occurrence  of  faucial  paralysis  following  it. 

While  /Etius  was  attracting  chief  attention  in  the  capital 
of  the  Eastern  Empire,  Alexander  of  Tralles,  in  Lydia,  at- 
tained a  similar  position  in  Rome.  He  was  born  in  Tralles, 
525  A.  D.,  the  son  of  a  physician  named  Stephen.  His  early 
education  was  directed  by  his  father  and  a  friend  or  patron 
whom  he  calls  Cosmas.  He  had  four  brothers,  all  of  whom 
were  noted  for  their  learning  and  success  in  various  callings. 
His  father  and  his  brother  Dioscurus,  who  was  also  a  phy- 
sician, subsequently  settled  in  Constantinople,  where  they 
attained  to  influential  positions.  Alexander,  after  complet- 
ing his  home  education,  traveled  and  practised  in  Cyrene, 
Greece,  Italy,  Gaul  and  Spain,  and  finally  settled  in  Rome, 
where  he  enjoyed  a  high  reputation  until  his  death,  605  A.  D. 
After  he  had  attained  an  age  rendering  him  incapable  of 
active  practice,  he  wrote  a  highly  interesting  work  on  pure- 
ly practical  medicine  as  distinguished  from  operative  sur- 
gery. He  did  not,  like  Orabasius  and  Cselius  Aurelianus, 
fill  his  work  with  collations  from  preceding  authors,  but 
founded  it  largely  upon  his  own  experience  and  observations. 
He  commenced  with  diseases  affecting  the  head  and  pro- 
ceeded in  order  downwards,  ending  with  those  affecting  the 
feet.  His  work  was  written  in  Greek  and  consisted  of  twelve 
books  or  parts,  styled  "Libri  duodecim  de  re  Medica",  under 
which  title  the  whole  work  was  translated  into  Latin  and  re- 
published in  1549.  He  regards  fevers  as  caused  chiefly  by 
irritation  or  disease  of  the  stomach  and  intestines ;  recom- 
mends a  seton  or  the  establishment  of  suppuration  at  the 
seat  of  the  aura  accompanying  paroxysms  of  epilepsy ;  and, 
contrary  to  the  instructions  of  both  Hippocrates  and  Galen, 
he  declared  that  venesectiot  could  be  practised  properly  on 
either  side  or  in  any  convenient  part,  as  the  veins  were  all 
connected  with  each  other. 

In  physical  diagnosis,  he  applies  pressure  of  the  finger 
to  detect  oedema  or  anasarca;  palpation  in  enlargement  of 
the  spleen;  percussion  in  tympanites  and  succussion  in  as- 
cites. He  attached  much  importance  to  the  consideration  of 
the  constitution,  personal  habits  and  age  of  his  patients.    He 


42 

cautions  against  implicitly  following  "Authorities" ;  yet  he 
treats  both  contemporaries  and  predecessors  with  respect, 
and  even  eulogizes  Galen. 

Paul,  or  Paulus,  of  -Hgina,  sometimes  called  .l^ginata, 
appears  to  be  the  last  of  the  Greek  physicians  who  gained  a 
prominent  position  in  medical  history.  He  was  born  in  the 
Island  of  JEgms.,  probably  near  the  end  of  the  sixth  cen- 
tury, received  his  medical  education  chiefly  at  Alexandria, 
traveled  and  practised  in  many  countries  and  enjoyed  a  high 
reputation  in  both  surger>'  and  midwifery,  during  the  reign 
of  the  Emperors  Heraclius  and  Constantius,  during  the  mid- 
dle part  of  the  seventh  century  A.  D.  It  was  during  the 
early  part  of  his  career  that  Alexandria  was  captured  by  the 
Saracens,  under  the  direction  of  the  Caliph  Omar,  640  A.  D., 
and  the  celebrated  library  finally  completely  destroyed  by 
fire.  Paulus  appears  to  have  been  strictly  an  itinerant  prac- 
titioner, with  no  permanent  place  of  residence,  though  the 
greater  part  of  his  life  was  spent  in  Egypt,  Arabia  and  other 
parts  of  Asia  Minor.  He  wrote  a  general  treatise  on  medi- 
cine and  surgery,  composed  of  seven  books  or  parts,  in  which 
he  gave  freely  his  own  views  and  methods  of  practice,  inter- 
spersed with  copious  extracts  from  Oribasius,  Soranus  and 
others. 

The  work  was  highly  esteemed  by  the  Arabians  and  was 
translated  into  their  language  and  became  the  basis  of  much 
of  their  subsequent  progress  in  the  healing  art ;  and,  as  a 
w^hole,  it  probably  aftords  the  best  index  of  the  actual  con- 
dition of  practical  medicine,  surgery  and  midwifery  at  the 
close  of  Greek  and  Roman  dominance,  and  the  beginning  of 
the  Arabian  school  in  the  middle  of  the  seventh  century  A.  D. 

The  sixth  book  in  his  series  was  devoted  to  surgery,  and 
shows  that  much  progress  had  Ijeen  made  both  in  devising 
instruments  and  in  their  use.  He  recommended  and  prac- 
tised scarification,  venesection  and  arteriotomy,  always  bleed- 
ing as  near  as  possible  to  the  affected  organ ;  applied  the 
actual  cauter}'  for  the  relief  of  deep-seated  abscesses ;  washed 
out  the  bladder  freely  in  chronic  cystitis ;  ligated  the  veins  in 
varicocele  and  treated  hydrocele  by  incision ;  endeavored  to 
reduce  dislocations  and  applied  splints  to  fractures  as  soon 


43 

after  the  injuries  as  possible,  and  forbade  frequent  changing 
of  dressings.  He  advised  trephining  immediately  after  frac- 
tures of  the  skull ;  practised  paracentesis  of  both  chest  and 
abdomen,  also  undertook  tracheotomy,  bronchotomy  and 
lithotomy,  and  advised  punctures  of  the  membranes  in  hy- 
drocephalus. He  used  a  variety  of  forceps  for  the  extrac- 
tion of  teeth,  and  for  the  removal  of  foreign  bodies  lodged 
in  the  flesh,  and  dilated  rectal  strictures  by  bougies.  He  de- 
scribed with  considerable  accuracy  syphilitic  ulcers  on  the 
genital  organs  of  both  male  and  female  patients,  and  also 
gonorrhoea,  but  apparently  without  any  knowledge  of  their 
specific  causes  or  infectiousness.  In  diseases  of  the  uterus 
he  used  the  vaginal  speculum  freely,  by  which  he  was  en- 
abled to  recognize  fissures,  excrescences,  polypi  and  other 
morbid  conditions  of  the  vagina  and  neck  of  the  uterus. 

In  general  practice  he  gave  opium  in  tetanus  and  other 
painful  affections;  practised  venesection  in  apoplexy;  used 
bathing  and  restricted  diet  in  fevers,  and  did  not  deviate 
much  from  the  rules  inculcated  by  Galen. 

The  brief  account  now  given  of  the  leading  medical  men 
of  the  first  six  centuries  A.  D.,  whose  writings  and  modes  of 
practice  have  come  to  us  sufficiently  authenticated,  afford  a 
fair  view  of  the  progress  of  medicine  during  that  period. 
The  almost  constant  wars  that  were  prosecuted  during  that- 
time  created  an  equally  constant  demand  for  surgeons  to 
care  for  the  wounded  and  physicians  for  the  sick.  This  led 
each  successive  ruler,  whether  Christian  or  pagan,  to  secure 
for  himself  and  his  soldiers  the  services  of  the  most  emi- 
nent medical  men  within  the  sphere  of  his  influence.  This 
led  to  a  steady  advance  in  practical  surgery,  especially  in  the 
invention  of  instruments  and  operative  procedures,  and  the 
writers  of  new  works  aimed  largely  at  the  collection  of 
whatever  was  deemed  valuable  in  the  writings  of  their  prede- 
cessors. The  investigations  in  comparative  anatomy  and 
physiology  that  had  been  prosecuted  with  varying  activity 
and  success  from  the  time  of  Aristotle  to  Galen,  had  been  al- 
most wholly  neglected  since.  Consequently  no  advance  had 
been  made  in  these  important  branches  of  medical  science, 


44 

and  the  whole  tenor  of  medical  and  surgical  practice  was  de- 
cidedly eclectic  and  empirical. 

Notwithstanding  the  degraded  condition  of  medicine  in 
the  Roman  Empire  prior  to  the  conquest  of  Greece,  and  the 
bitter  Roman  prejudices  against  the  introduction  of  Grecian 
philosophy  and  medicine,  the  great  superiority  of  the  latter 
was  soon  demonstrated  by  the  influx  of  men  educated  at 
Alexandria,  which  soon  caused  their  services  to  be  required, 
not  only  with  their  armies  but  also  in  the  cabinets  and  house- 
holds of  the  successive  emperors.  Educated  members  of  the 
profession  were  soon  permitted  to  enjoy  all  the  rights  of  cit- 
izenship ;  and  during  the  reign  of  Antonius  Pius,  in  the  last 
half  of  the  fourth  century  A.  D.,  they  were  granted  many 
special  privileges,  and  some  restrictions  were  placed  upon 
the  custom  of  allowing  anyone  to  practise  who  might  choose 
to  do  so.  The  physician  to  the  King  or  Emperor  was  called 
Archiater,  or  royal  healer.  Popular  Archiaters  were  also 
appointed,  whose  duty  it  was  to  attend  to  the  poor  and  to 
perform  many  of  the  duties  at  present  assigned  to  public 
health  officers.  Such  were  paid  moderate  salaries  from  the 
public  treasury,  and  where  such  officers  existed  no  persons 
were  alloweed  to  commence  the  practice  of  medicine  without 
an  examination  and  license  by  the  Archiater  of  the  District. 

Notwithstanding  this  partial  organization  of  the  better 
educated  members  of  the  profession  and  fair  recognition  of 
their  social  standing  in  the  Roman  Empire,  a  large  part  of 
medical  practice  remained  in  the  hands  of  the  more  ignorant 
and  superstitious  part  of  the  population.  The  rapid  decline 
and  closure  of  the  ^sclepiadae,  so  long  the  chief  resorts  for 
the  sick  and  centers  for  medical  instruction,  following  the 
edict  of  Constantine  against  them  in  335  A.  D.,  made  it  nec- 
essary to  provide  substitutes  both  for  the  care  of  the  sick  and 
for  the  preservation  and  increase  of  medical  knowledge.  The 
monasteries  under  the  control  of  monks  and  priests  became 
the  most  ready  substitutes,  especially  as  healing  of  the  sick 
and  help  for  the  poor  were  inculcated  as  cardinal  duties  of 
the  Christian  life.  And  as  healing  of  the  sick  and  restoring 
the  dead  to  life  were  resorted  to  by  the  author  of  Christian- 
ity and  his  immediate  disciples  as  evidence  of  the  truth  of 


45 

their  doctrines  and  their  divine  origin,  it  exerted  great  influ- 
ence in  again  connecting  medicine  with  religious  institutions 
under  the  control  of  the  priesthood.  The  same  influences 
created  in  the  minds  of  the  female  converts  to  Christianity 
great  zeal  in  prosecuting  charitable  enterprises  of  various 
kinds.  Consequently,  while  the  Emperor  Constantine  was 
enforcing  his  decree  for  closing  the  ^sclepiad^e  and  all  med- 
ical institutions  under  what  was  called  pagan  control  or 
Greco-Roman  philosophy  that  recognized  the  worship  of 
many  Gods,  his  mother,  Helena,  was  devoting  much  of  her 
time  and  means  to  the  founding  of  a  genuine  hospital  for 
the  sick  and  poor  in  Jerusalem.  With  the  aid  of  many  others 
another  was  established  at  Antioch  about  363  A.  D.,  and  as 
early  as  373  A.  D.  a  still  more  noted  one  was  organized  at 
Csesarea. 

Such  was  the  beginning  of  the  modem  system  of  hospi- 
tals, asylums,  and  dispensaries  for  the  sick  and  helpless  that 
are  now  found  in  all  the  countries  of  Christendom.  The 
founding  of  these  institutions  also  led  to  the  appointment  of 
some  person  to  prepare  and  dispense  the  medicines  ordered 
by  the  physicians.  And  this  was  doubtless  one  of  the  chief 
influences  creating  the  order  of  pharmacists,  or  apothecaries, 
as  distinct  from  that  of  the  physician. 


46 


CHAPTER  IV. 

HISTORY    OF    MEDICINE    FROM    THE    SEVENTH    TO    THE   FOUR- 
TEENTH   CENTURY. — THE   ARABIAN    ERA. 

In  the  preceding  chapter  the  history  of  medical  progress 
was  traced  from  the  time  of  Galen,  the  second  century  A.  D., 
to  the  seventh  century  A.  D.  During  that  period  the  great 
Roman  Empire  had  culminated  in  its  greatness  and  divided 
into  Eastern  and  Western  Empires ;  and  Rome,  only  a  little 
before  mistress  of  the  world,  had,  under  the  repeated  at-- 
tacks  of  so-called  Northern  barbarians  and  the  effect  of  in- 
ternal dissensions,  become  little  more  than  a  heap  of  ruins. 
The  Eastern  Empire,  with  its  capital  at  Constantinople,  was 
still  maintaining  a  semblance  of  power,  though  its  downfall 
was  rapidly  approaching.  During  the  same  period  the  gen- 
eral aspect  of  medicine  had  undergone  an  equally  radical 
change.  The  renowned  school  of  Alexandria,  with  its  li- 
brar}-  and  museum,  had  been  destroyed.  The  rapid  spread  of 
Christianity  and  its  dominating  influence  throughout  the 
Roman  Empire  had  resulted  in  suppressing  nearly  all  the 
i^sclepiadae  and  associated  medical  schools.  By  doing  so 
the  intimate  and  long-continued  connection  of  medicine  with 
the  ever-varying  systems  and  schools  of  Grecian  and  Greco- 
Roman  philosophy  was  effectually  broken  up.  Alany  of  the 
educated  members  of  the  medical  profession  embraced  the 
Christian  doctrines,  and  served  as  Archiators,  and  many  oth- 
ers joined  the  monasteries  and  the  newly  organized  hospitals 
for  the  sick  and  again  reunited  the  functions  of  both  physi- 
cian and  priest. 

\\'hen  the  Emperor  Justinian,  529  A.  D.,  finally  closed  the 
only  remaining  important  /Esclepion  at  Acropolis,  and  the 
Platonic  School  at  Athens,  their  occupants,  together  with 
many  of  the  Greek  and  Roman  scholars,  migrated  into  Svria, 
Arabia  and  other  parts  of  Asia.  They  carried  with  them 
copies  of  the  best  works  of  the  Greek  and  Roman  authors, 
from  Hippocrates  to  Galen.  They  were  cordially  received  by 
Mahommed  and'Chosroes,  King  of  Persia,  and  by  translat- 


47 

ing  their  valuable  medical  books  into  the  Syriac  and  Arabic 
languages  they  were  readily  introduced  into  the  schools  at 
Bagdad,  Bassora  and  Damascus.  Their  work  in  thus  laying 
the  foundation  for  an  Arabian  era  of  medicine  was  much 
aided  by  a  schism  that  had  occurred  among  the  Christians 
in  Constantinople.  Nestorius,  sometimes  called  Bishop  Nes- 
tor, had  been  appointed  Patriarch  of  Constantinople,  428 
A.  D.,  and  with  his  numerous  followers  controlled  an  impor- 
tant school  at  Edessa.  The  school  was  accompanied  by  a 
hospital  for  the  sick,  in  which  the  medical  students  received 
some  clinical  instruction.  After  a  few  years  Nestorius  was 
subjected  to  a  charge  of  heresy,  which  led  to  much  theo- 
logical controversy  and  resulted  in  his  banishment  and  the 
closure  of  the  school  by  the  Emperor  Zeno,  489  A.  D. 

The  school  was  under  the  charge  of  an  able  faculty  of 
teachers  who,  with  most  of  the  followers  of  Nestorius,  fled 
into  Syria  and  Arabia  and  soon  founded  another  school  at 
Nisibus,  in  Mesopotamia.  They  carried  with  them  copies 
of  many  of  the  best  works  of  Greek  and  Roman  authors  in 
both  philosophy  and  medicine,  and  Bishop  Ibas,  aided  by 
Cumas  and  Probus,  attached  tp  the  new  school,  translated 
the  works  of  Aristotle  into  Syriac,  and  the  school  was  much 
patronized  by  Jewish,  Syrian  and  Arabian  scholars  and  stu- 
dents of  medicine.  Some  historians  have  credited  these 
Nestorian  schools,  both  at  Edessa  and  Nisibus,  with  having 
been  the  first  to  require  a  definite  course  of  study  in  medi- 
cine, and  to  grant  certificates  authorizing  the  holders  to 
practise  the  healing  art.  And  it  was  also  largely  through 
their  influence  that  pharmacies  for  the  preparation  and  dis- 
pensing of  medicine  became  a  distinct  business  separate  from 
the  practice  of  medicine. 

It  was  thus  by  the  influence  of  the  migration  of  the  Nes- 
torians  from  Constantinople  and  Edessa,  and  the  closing  of 
the  schools  at  Acropolis  and  Athens  by  Justinian,  that  the 
Greek  and  Roman  philosophy  and  medicine  became  trans- 
ferred to,  and  firmly  established  in,  the  schools  of  Syria, 
Arabia  and  Persia,  and  were  fostered  by  Chosroes,  King  of 
Persia,  IMahommet  and  their  successors  from  the  sixth  to 
the  eleventh  century  A.  D.,  constituting  a  distinct  era  in  the 


48 

progress  of  medicine  as  well  as  in  the  progress  of  nations, 
an  era  in  wiiich  Xisibus,  Uagdad,  Bassora  and  Damascus  be- 
came the  chief  seats  of  learning  instead  of  Athens,  Alexan- 
dria, Rome  and  Constantinople. 

The  first  physicians  to  gain  general  reputation  in  Arabia 
were  from  a  Nestorian  family  named  Bachtishua  (i.  e..  Serv- 
ants of  Christ).  Bachtishua  ben  Jurjis  is  said  to  have  cured 
the  Caliph  Haroun  el  Raschid  of  headache  by  venesection, 
while  his  son  cured  the  same  Caliph  of  an  attack  of  apo- 
plexy. Another  Nestorian  physician,  named  ]\Iesue,  the 
Elder,  gained  a  high  reputation  as  a  translator  of  valuable 
Greek  and  Latin  works  into  the  Syriac  and  Arabian  lan- 
guages, and  in  the  early  part  of  the  ninth  century  was  di- 
rector of  the  hospital  in  Bagdad. 

Honain,  of  Hira,  was  another  prolific  translator  of  med- 
ical, philosophical  and  scientific  works,  for  which  he  received 
as  compensation  the  weight  of  the  manuscript  in  gold.  He 
became  widely  known  as  a  physician  and  writer  on  some 
medical  topics.  He  appears  to  have  adopted  many  of  the 
more  fanciful  doctrines  of  Galen  and  Plato,  but  left  no  ad- 
ditions to  the  sum  of  real  medical  knowledge.  He  was  born 
in  809  and  died  in  873  A.  D. 

Rliazes,  born  at  Rai,  850  A.  D.,  was  one  of  the  most  emi- 
nent of  the  Arabian  writers  and  practitioners  of  both  medi- 
cine and  surgery  during  the  last  part  of  the  ninth  century. 
He  became  one  of  the  most  eminent  teachers  of  medicine  in 
the  school  ot  Bagdad.  He  wrote  many  works  on  both  philos- 
ophy and  medicine,  but  the  two  most  important  were  his  "El 
Hawi"  or  Liber  Continens,  and  his  Aphorisms,  which  were 
retained  in  use  during  several  centuries.  These  works  show 
that  he  was  familiar  with  many  surgical  procedures,  such  as 
were  required  in  the  treatment  of  trichiasis,  entropion,  ectro- 
pion, cataract  and  fistula  lachrymalis,  also  with  tracheotomy, 
tonsillotomy,  and  the  removal  of  necrosed  and  carious  bones, 
the  closure  of  hare-lip  and  fistulous  tracts.  His  teachings  in 
anatom}-,  physiology-  and  pathology  show  no  advance  beyond 
what  had  been  derived  from  translation  of  the  works  of 
Galen  and  other  Greek  and  Roman  authors. 

In  the  treatment  of  diseases  he  adheres  closely  to  the 


49 

principles  inculcated  by  Hippocrates,  but  in  semeiology  and 
prognosis  he  makes  some  valuable  additions  to  our  previous 
knowledge.  His  excellent  descriptions  of  smallpox  and 
measles  are  the  earliest  that  have  been  handed  down  to  us, 
and  justly  entitle  him  to  the  position  of  a  pioneer  in  derma- 
tology. To  the  materia  medica  he  added,  for  external  use, 
preparations  of  arsenic,  sulphate  of  copper,  and  mercurial 
ointment.  Late  in  life  he  became  blind  and  poor,  and  died 
in  his  native  city  in  923  A.  D. 

Closely  following  Rhazes  was  Ali  Abbas,  an  Arabian 
physician  who  compiled  the  "Royal  Book"  or  treatise  on 
medicine,  which  was  later  translated  into  Latin  by  Constan- 
tius  Africanus,  who  was  the  first  author  to  introduce  the 
Arabian  writings  into  Europe. 

Perhaps  the  most  eminent  of  the  Arabian  physicians  was 
Avicenna,  a  native  of  Bokhara,  bom  in  980  A.  D.  His 
Oriental  education  consisted  in  a  complete  knowledge  of  the 
Koran  before  he  had  passed  his  tenth  year  of  age.  He  then 
rapidly  acquired  a  knowledge  of  grammar,  arithmetic,  geom- 
etry, dialectics  and  astronomy.  He  next  made  a  thorough 
study  of  the  philosophy  of  Aristotle,  and  then  commenced  the 
study  of  medicine  under  Nestorian  teachers  at  Bagdad.  Such 
was  his  proficiency  that  at  the  age  of  sixteen  years  he  was 
declared  to  be  qualified  to  teach  and  practise  his  profession. 
Five  years  later  he  had  written  an  encyclopedia  entitled  by 
him,  "Book  of  the  Sum  Total".  Later,  he  became  the  author 
of  many  works  and  commentaries,  the  most  important  of 
which  was  the  "Canon",  in  which  he  gave  an  excellent  colla- 
tion of  the  views  of  many  of  the  most  eminent  Greek  authors. 
It  was  translated  into  both  Latin  and  Hebrew,  and  was  in 
general  use  for  four  or  five  centuries  in  Europe  as  well  as  in 
Asia.  Early  in  his  career  he  became  Vizier  to  the  Emir  of 
Hamadan,  and  lectured  on  both  philosophy  and  medicine,  at 
the  close  of  each  lecture  indulging  in  feasting  and  dancing. 
After  the  death  of  the  Prince  of  Hamadan,  Avicenna  was 
suspected  of  improper  correspondence  with  parties  at  Ispa- 
han, and  thrown  into  prison.  After  being  liberated  he  fled 
to  Ispahan,  where  he  again  attained  a  high  reputation,  aban- 
doned the  excesses  of  his  earlier  years,  freed  his  slaves,  gave 


50 

much  of  his  fortune  to  the  poor,  and  died  at  the  age  of  fifty- 
eight  years.  Notwithstanding  the  high  reputation  attained 
by  Avicenna  and  the  length  of  time  that  his  "Canon"  was 
accepted  as  authority,  we  find  in  it  but  little  that  is  new  or  in 
addition  to  what  was  previously  known.  In  his  comments  on 
materia  medica  he  recommends  the  internal  use  of  camphor, 
preparations  of  iron,  cubebs,  aloes,  manna,  amber,  sublimate, 
and  gold  and  silver  as  blood  purifiers,  which  shows  a  decided 
tendency  to  use  more  mineral  and  chemical  remedies  than 
any  of  his  predecessors. 

No  true  science  of  chemistry  had  yet  been  developed,  but 
the  alchemistic  theory  of  a  philosopher's  stone,  an  elixir  of 
life,  and  the  transmutation  of  metals,  more  or  less  prevalent 
among  the  Eg}'ptians,  Greeks  and  Romans  as  early  as  the 
fifth  century  A.  D.,  found  enthusiastic  disciples  among  the 
Arabians.  Many  of  them  experimented  actively,  especially 
in  efforts  to  rend-er  the  metals  soluble  and  thereby  transmute 
the  less  valuable  into  gold  or  silver.  Perhaps  Jaffar,  or 
Geber,  who  lived  during  the  last  half  of  the  eighth  century 
A.  D.,  became  the  most  eminent,  and  made  some  discoveries 
of  importance.  Previous  to  his  time  the  strongest  acid  known 
was  concentrated  vinegar.  He,  however,  succeeded  in  mak- 
ing nitric  acid  by  distilling  a  mixture  of  blue  vitriol,  alum 
and  saltpetre ;  and  he  made  aqua  regia  or  nitro-muriatic  acid 
by  adding  to  the  same  mixture  sal-ammoniac  (ammonia  hy- 
drochlorate).  With  his  aqua  regia  he  was  enabled  to  dis- 
solve gold,  an  object  long  sought  in  vain  by  his  predecessors. 
He  also  described  the  absorption  and  evolution  of  gases  by 
and  from  liquids  and  solids,  and  was  familiar  with  the  pro- 
cesses of  filtration,  distillation  and  sublimation. 

Rhazes,  while  chief  physician  to  the  hospital  in  Bagdad, 
made  sulphuric  acid  by  distilling  green  vitriol,  and  also  ab- 
solute alcohol  by  distilling  spirits  over  quicklime. 

While  the  Arabian  schools  were  thus  conserving  all  that 
was  valuable  in  the  Greco-Roman  medicine  and  philosophy 
and  making  here  and  there  some  valuable  additions,  the  fol- 
lowers of  ]^Iahommet  had  rapidly  gained. control  over  Arabia, 
Persia  and  the  greater  part  of  Asia  Minor,  and  before  the 
end  of  the  seventh  centun^  had  defeated  the  Eastern  Roman 


51 

government  at  Constantinople  and  led  their  Saracen  legions 
through  the  whole  southern  part  of  Europe.  In  doing  so, 
they  brought  back  into  Europe  all  that  was  valuable  in  Gre- 
cian and  Roman  learning,  dressed  in  Arabic  language,  with 
such  additions  as  have  been  indicated,  and  re-established  a 
school  of  medicine  at  Salernum,  a  former  health  resort  near 
Naples,  and  subsequently  schools  at  Montpellier,  Cordova 
and  Seville.  These  schools,  as  well  as  those  at  Bagdad  and 
Damascus  in  Asia,  received  the  fostering  care  of  the  suc- 
cessive Moorish  Caliphs,  and  constituted  the  chief  seats  of 
learning,  including  medicine,  during  the  eighth,  ninth,  tenth 
and  eleventh  centuries,  which  was  pre-eminently  the  era  of 
Arabian  medicine.  Though  not  characterized  by  any  great 
discoveries,  it  is  justly  credited  with  having  received  and 
fostered  the  most  valuable  part  of  Egyptian,  Grecian  and 
Roman  medicine  and  literature,  as  they  were  driven  out  of 
Europe,  and  again  in  due  time  re-established  them  in  Italy 
and  Spain,  from  which  they  were  finally  redistributed  to  all 
parts  of  Europe,  constituting  the  period  styled  in  history  "the 
revival  of  learning"  following  the  dark  ages. 

The  Arabians  are  credited  w'th  not  only  the  addition  of 
several  valuable  remedies  to  the  materia  medica  and  the  dis- 
covery of  the  mineral  acids,  but  also  the  preservation  of  a 
distinctly  medical  profession  based  on  a  clinical  study  of  dis- 
eases, their  remedies,  and  some  elements  of  natural  science, 
with  less  reference  to  theology  or  supernatural  agencies. 

The  overthrow  and  final  extinction  of  Arabian  leadership 
or  even  activity  in  medicine  came  when  in  1236  A.  D.  Cor- 
dova fell  under  the  control  of  Ferdinand  of  Castile,  and  in 
1258  A.  D.  Bagdad  was  taken  possession  of  by  the  Tartars. 
Aside  from  what  has  been  said  concerning  Nestorian  and 
Arabian  schools,  very  little  progress  was  made  in  any  de- 
partment of  medicine  from  the  end  of  the  seventh  to  the  be- 
ginning of  the  fourteenth  century.  Medical  and  nearly  all 
other  sciences  and  arts  retreated  to  the  monasteries  and  the 
care  of  monks  and  ecclesiastics,  who  were  far  more  influ- 
enced by  papal  edicts  and  so-called  supernatural  agencies 
than  by  clinical  observation  and  experimental  inquiry.  Yet, 
during  all  this  dark  period,  influences  were  visibly  prepar- 


52 

ing  the  way  for  the  revival  of  learning  that  followed.  Im- 
portant monas'uic  schools  were  founded  in  England  at  Ox- 
ford, 635  A.  D.,  and  at  Cambridge,  670  A.  D.,  and  Charles 
I.,  King  of  France,  better  known  as  Charlemagne,  who  for 
more  than  thirty  years  prosecuted  a  relentless  and  successful 
war,  during  which  he  subdued  the  inhabitants  of  Saxony, 
Lombardy,  and  Bavaria,  and  compelled  them  to  adopt  the 
Christian  faith,  as  expounded  by  papal  authority,  became  al- 
so a  zealous  patron  of  learning  and  the  arts.  lie  invited  to 
his  court  men  of  learning  from  Italy,  and  established  th& 
"Palatine  School,"  which,  like  our  normal  schools,  was  de- 
signed to  qualify  persons  to  teach  arithmetic,  grammar,  rhet- 
oric, logic,  history,  astronomy,  theology  and  medicine,  and 
then  had  them  go  into  the  provinces  and  keep  alive  some 
educational  work  among  the  people.  After  the  death  of 
Charlemagne  the  vast  empire  constructed  by  him,  extending 
from  the  English  Channel  to  the  western  borders  of  Asia, 
underwent  rapid  disintegration  into  many  petty  kingdoms, 
and  all  learning,  professional  and  otherwise,  remained  under 
the  dominating  influence  of  the  monks,  priests  and  bishops, 
among  which  those  of  the  Order  of  St.  Benoit  enjoyed  the 
highest  reputation  for  medical  skill. 

Notwithstanding  the  religious  rites  of  the  Jewish  Church 
forbade  all  attention  to  the  diseases  of  Christians  many  Jews 
studied  medicine  under  Arabian  physicians  and  retained  a 
fair  share  of  medical  practice  until  near  the  end  of  the 
eleventh  century,  when  the  preaching  of  Peter  the  Hermit 
began  to  kindle  throughout  all  Europe  the  wild  fires  of  the 
Crusades. 

During  all  those  preceding  centuries  besides  the  Monks, 
Priests  and  Jews  who  maintained  some  semblance  of  educa- 
tion, there  were  large  numbers,  including  barbers,  servants 
and  slaves,  both  male  and  female,  with  no  education,  who  en- 
deavored to  administer  to  the  sick  and  wounded  wherever 
they  were  met  with.  There  were  no  courses  of  study  pre- 
scribed to  qualify  any  person  to  engage  in  practice,  nor  laws 
forbidding  anyone  to  practice  who  might  desire  to  do  so. 
For  though  the  Xestorian  schools  were  said  to  grant  certifi- 
cates to  such  as  had  completed  certain  studies,  and  Theo- 


53 

doric,  King  of  the  Visigoths,  issued  a  decree  requiring  every 
physician  and  surgeon  to  make  full  restitution  for  any  in- 
juries suffered  by  patients  while  under  their  treatment, 
neither  forbade  any  to  engage  in  practice.  The  medical 
school  that  had  been  founded  during  the  latter  part  of  the 
seventh  century  A.  D.,  at  Salernum,  being  directly  on  the 
route  of  the  Crusading  legions  from  Europe  to  Jerusalem 
or  the  Holy  Land,  near  the  end  of  the  eleventh  ceutury  re- 
ceived a  great  increase  of  patronage  and  remained  the  most 
important  center  of  medical  instruction  until  the  beginning 
of  the  fourteenth  -century.  It  was  at  that  institution  that 
Robert,  of  Normandy,  on  returning  from  the  siege  of  Jerusa- 
lem with  a  wounded  arm,  remained  until  recovery.  On  leav- 
ing he  was  presented  with  a  Latin  poem  entitled  "Regimen 
Sanitatis  Salemi",  which  was  received  with  great  popular 
favor,  and  was  published  in  this  country  by  Dr.  Ordronaux 
in  1 87 1.  The  most  important  lesson  inculcated  in  the  poem 
is  contained  in  the  following  lines  addressed  to  England's 
King : 

"If  thou  to  health  and  vigor  wouldst  attain, 
Shun  mighty  cares,  all  anger  deem  profane ; 

From  heavy  suppers  and  much  wine  abstain ;  ^ 

Nor  trivial  counfit  after  pompous  fare 
To  rise  from  the  table  and  to  take  the  air. 
Shun  idle  noonday  slumbers,  nor  delay 
The  urgent  calls  of  nature  to  obey. 
These  rules  if  thou  wilt  follow  to  the  end. 
Thy  life  to  greater  length  thou  may'st  extend." 

-(Ord.) 

During  the  first  half  of  the  thirteenth  century,  by  the 
fostering  care  of  Frederick  II.,  King  of  Naples,  the  school  at 
Salernum  reached  the  zenith  of  its  prosperity  and  influence. 
The  "Compendium  Salernitanum",  the  chief  medical  text- 
book of  the  school,  was  designed  to  include  all  the  depart- 
ments of  medicine  and  was  the  work  of  six  writers  each 
eminent  in  his  department.  It  was  thus  the  prototype  of  our 
modern  encyclopedias  or  works  of  many  authors.  The  sev- 
eral  writers   simply   made   fairly   good   compilations    from 


•^ 


54 

Arabian,  Grecian  and  Roman  authors,  and  their  work  re- 
mained a  popular  text-book  not  only  in  Salernum  but  also 
in  the  schools  at  Bologna,  Padua,  Pavia,  Montpellier,  Cor- 
dova and  Paris,  for  the  increased  demand  for  accommoda- 
tions for  the  sick  and  wounded  during  and  following  the 
vast  military  operations  of  the  Crusades  led  to  a  rapid  in- 
crease in  the  number  of  monasteries,  hospitals  and  medical 
schools. 

During  the  first  half  of  the  twelfth  century  Nicholas 
Prsepositus,  President  of  the  school  at  Salernum,  wrote  a 
work  on  pharmacy  called  the  "Antidotarum"  that  acquired 
great  popularity.  He  used  in  his  work  the  well-known  sys- 
tem of  apothecaries'  weights  and  measures,  and  is  said  to 
have  given  one  prescription  from  St.  Paul  and  others  from 
the  Prophet  Elias.  In  none  of  the  works  produced  by  the 
patrons  of  this  school  do  we  find  any  really  valuable  addi- 
tions in  any  department  of  the  field  of  medicine.  They  gave 
chief  attention  to  materia  medica  and  practical  medicine,  gen- 
erally following  closely  the  doctrines  of  Hippocrates  and 
Galen,  especially  in  regard  to  baths,  diet,  the  use  of  mild  lax- 
atives, and  free  venesection  in  the  more  acute  inflammatory 
aflfections.  Anatomy  and  physiology-  appear  to  have  made 
no  progress  from  the  time  of  Galen  to  the  end  of  the  thir- 
teenth century,  in  any  of  the  medical  schools  of  Europe,  as 
both  Christians  and  pagans  still  regarded  any  dissection  of 
the  human  body  for  the  purpose  of  gaining  useful  knowledge 
as  sacrilege. 

Yet  early  in  the  thirteenth  century,  Frederick  II.  pub- 
lished an  edict  forbidding  any  person  from  practising  medi- 
cine in  the  Kingdom  of  Naples  until  after  an  examination  by 
the  Faculty  of  the  School  of  Salernum  on  the  Therapeutics 
of  Galen,  the  first  Book  of  Avicenna  and  the  Aphorisms  of 
Hippocrates,  text-books  from  six  to  sixteen  centuries  old. 

One  prominent  characteristic  of  medical  writers  during 
the  twelfth  and  thirteenth  centuries  was  the  adoption  of  a 
poetic  or  versified  mode  of  expression.  Thus,  ^gidius,  of 
Corbeil,  physician  to  King  Philip  Augustus,  wrote  in  verse 
on  "De  Urinus",  "De  Pulsibus"  and  "De  Laudibus  et  Vir- 
tutibus  Compositorium  Medicaminum*',  and  Alcadinus,  of 


55 

Syracuse,  physician  to  Frederick  II.,  composed  a  poem  on 
"De  Balner's  Puteolanis".  He  was  also  one  of  the  teachers 
at  Salernum. 

Another  marked  feature  of  the  same  centuries  was  the 
unusual  number  of  women  who  studied  and  practised  the 
healing  art,  and  in  some  instances  became  teachers  and  writ- 
ers, thereby  again  reminding  us  that  women  practitioners  of 
medicine  are  by  no  means  the  exclusive  product  of  the  last 
half  of  the  nineteenth  century.  Perhaps  the  persistent  ex- 
perimental search  for  the  philosopher's  stone  and  elixir  of 
life  by  the  alchemists,  and  the  religious  enthusiasm  of  the 
Crusaders,  so  elevated  the  mind  of  man  that  his  ideas  on  the 
most  common  topics  had  to  be  expressed  in  poetry,  and  that 
of  woman  that  she  was  compelled  to  pass  from  the  family 
circle  to  the  wider  field  of  medicine. 

It  is  more  probable,  however,  that  the  greater  tendency  of 
women  to  study  and  practise  medicine  during  this  dark  pe- 
riod of  human  history  was  caused  by  the  interest  she  felt  in 
the  organization  and  maintenance  of  hospitals  and  dispen- 
saries for  the  sick  and  helpless  under  Christian  dispensation, 
to  take  the  place  of  what  was  called  pagan  or  infidel  /Esclep- 
iadese  and  schools  of  philosophy  previously  existing. 

In  the  preceding  chapters  of  this  work  very  little  has  been 
said  concerning  the  character  of  the  epidemic  diseases  that 
are  known  to  have  prevailed  more  or  less  during  all  the  past 
ages,  and  especially  during  the  first  thirteen  centuries  A.  D. 
There  is  sufficient  evidence  in  both  the  historical  and  medical 
writings  to  show  that  from  the  earliest  periods  of  time 
chronic  diseases  of  the  nervous,  digestive  and  vascular  sys- 
tems, with  occasional  acute  inflammatory  attacks,  and  the 
endemic  fevers  of  malarial  or  periodical  type,  were  the  dis- 
eases ordinarily  met  with  in  all  the  inhabited  countries  of 
which  we  have  any  records.  That  the  allusions  to  fevers 
should  generally  indicate  those  of  periodical  form  was  evi- 
dently dependent  upon  the  fact  that  the  geological,  topo- 
graphical and  climatological  conditions  of  Eg}-pt,  Greece, 
Rome  and  Asia  Minor  were  such  as  to  favor  the  annual  prev- 
alence of  that  form  of  disease. 

In  addition,  however,  to  these  ordinary  diseases  there  are 


56 

in  the  earliest  historical  and  medical  records  indications  of 
the  prevalence,  at  irregular  intervals  of  time,  of  the  rapid  de- 
velopment and  wide  spread  of  acute  febrile  diseases,  resulting 
in  so  great  a  degree  of  mortality  as  to  cause  the  utmost  dread 
or  mental  anxiety.  Such  outbreaks  of  disease  are  called  epi- 
demics, and  from  the  earliest  times  they  were  indicated  by  the 
words  Pest,  Pestilentia  or  Plague.  Prior  to  the  commence- 
ment of  the  Christian  era,  and  for  several  centuries  later,  the 
prevalence  of  such  epidemics  was  very  generally  attributed 
to  the  anger  of  the  Gods  and  were  often  thought  to  be  pre- 
ceded or  accompanied  by  unusual  or  violent  natural  disturb- 
ances, such  as  earthquakes,  volcanic  eruptions,  the  appear- 
ance of  comets,  etc.  Consequently,  very  little  effort  was 
made  to  investigate  their  real  causes  or  to  devise  any  rational 
modes  of  treatment,  the  latter  generally  consisting  of  prayers, 
sacrifices,  the  kindling  of  bonfires,  etc. 

But  the  first  great  epidemic  of  the  Plague,  of  which  we 
have  a  reliable  history,  commenced  in  lower  Eg}-pt  in  542 
A.  D.  and  extended  up  the  Nile  and  eastward  into  Asia 
Minor,  and  soon  reached  Constantinople,  where  it  is  claimed 
that  more  than  5,000  human  beings  died  daily  when  the  dis- 
ease was  most  active.  The  next  year  it  extended  westward 
over  Greece  and  Italy,  and  in  545  it  invaded  Gaul  and  the 
next  year  reached  the  Rhine.  It  did  not  cease  its  activity  for 
twelve  or  fifteen  years,  during  which  time  it  decimated  the 
population  of  Paris  and  London,  as  well  as  most  of  the  dense- 
ly populated  parts  of  Europe,  Asia  and  Northern  Africa. 
As  this  great  and  destructive  epidemic  commenced  soon  after 
Justinian  I.  became  Emperor  at  Constantinople,  it  has  gen- 
erally been  designated  as  the  "Plague  of  Justinian".  The 
disease  continued  to  recur  with  varying  degrees  of  intensity 
at  intervals  of  from  fifteen  to  thirty  years,  commencing  gen- 
erally in  Eg}-pt,  Syria  or  on  the  eastern  borders  of  the  Med- 
iterranean Sea,  and  extending  over  most  of  the  countries  of 
Europe,  until  the  seventeenth  century. 

The  Plague  appears  to  have  been  a  highly  malignant 
typhus  fever,  frequently  terminating  fatally  in  from  one  to 
three  days,  and  when  more  protracted  becoming  complicated 
with  inflammation  of  the  lymphatic  glands  of  the  groin,  arm- 


57 

pit  and  neck,  thereby  giving  it  the  name  of  "Bubonic 
Plague".  With  the  glandular  swellings  in  many  cases  came 
also  carbuncles  on  the  back,  hips  and  legs,  and  if  the  patients 
lived  beyond  the  first  week  extensive  suppuration  generally 
took  place  in  both  glands  and  carbuncles  and  the  prospect 
of  final  recovery  was  increased.  The  outbreaks  of  the  plague 
generally  followed  closely  unusual  periods  of  famine,  wheth- 
er caused  by  failure  of  crops  or  the  ravages  of  war ;  the  ac- 
cumulations of  stagnant  and  impure  water  after  floods ;  and 
the  overcrowding  of  population  in  cities,  with  neglect  of  both 
ventilation  and  cleanliness. 

In  addition  to  the  epidemics  of  plague,  during  the  sixth 
and  seventh  centuries,  variola,  or  smallpox,  and  measles  were 
introduced  into  Europe  through  intercourse  with  Arabia,  and 
especially  through  the  Saracen  invasions.  They  had  doubt- 
less prevailed  in  India  and  China  at  a  much  earlier  period, 
but  were  first  clearly  described  by  the  Arabian  physicians 
Ahrun  and  Rhazes  in  the  seventh  century.  From  that  time 
to  the  introduction  of  vaccination,  near  the  end  of  the  eight- 
eenth century,  smallpox  recurred  in  epidemic  form  and 
spread  over  the  greater  part  of  Europe  at  such  frequent  in- 
tervals that  it  became  the  most  dreaded  scourge  of  mankind. 
The  best  of  English  medical  writers  have  estimated  that  the 
average  annual  mortality  from  this  disease  alone  exceeded 
200,000  for  the  whole  of  Europe.  This  great  mortality  was 
often  added  to  by  outbreaks  of  measles,  scarlet  fever  and 
diphtheria,  then  called  cynanche  maligna.  The  principal  rea- 
son why  the  whole  of  Europe  was  not  literally  depopulated 
during  the  centuries  directly  considered  in  this  chapter  by 
the  combined  influence  of  almost  constant  wars  and  pestilen- 
tial epidemics,  was  the  fact  that  those  who  survived  one  at- 
tack of  either  eruptive  fevers  or  plague  were  generally  ren- 
dered immune  or  exempt  from  subsequent  attacks  of  the 
same  disease. 


58 


CHAPTER  V. 

THE  HISTORY  OF  MEDICAL  PROGRESS  DURING  THE  FOURTEENTH, 
FIFTEENTH  AND  SIXTEENTH  CENTURIES. 


The  Origin  and  Development  of  Human  Anatomy  and  of 
Inorganic  Chemistry. 


The  beginning  of  the  fourteenth  century  A.  D.  was 
especially  characterized  by  renewed  attempts  to  study 
human  anatomy.  As  shown  in  the  preceding  chapters  the 
study  of  anatomy,  even  by  the  dissection  of  animals,  had 
been  almost  suspended  during  the  whole  of  the  Arabian 
era  of  medicine  and  the  re-establishing  of  medical  schools 
in  Europe  under  the  Christian  dispensation ;  i.  e.,  from  the 
second  to  the  fourteenth  century  A.  D.  But  the  constant 
demand  for  better  educated  physicians  and  surgeons  to 
accompany  the  armies  and  serve  in  the  hospitals,  made 
necessary  by  the  almost  constant  wars,  as  well  as  by  the 
frequently  recurring  epidemic  diseases,  rendered  a  better 
knowledge  of  the  anatomy  of  the  human  body  impera- 
tive. The  leading  influence  gained  by  the  Italian  Schools 
under  the  more  enlightened  policy  of  Frederick  II.,  and 
the  increasing  demand  for  experimental  inquries  by  the 
Alchemists,  awakened  a  bolder  spirit  of  inquiry  in  other 
directions.  In  accordance  with  this  spirit  Dr.  Mondino  de 
Luzzi,  Professor  of  Anatomy  in  the  school  at  Bologna, 
boldly  caused  a  human  body  to  be  dissected  before  his 
class  of  medical  students  in  1306.  Not  possessing  quite 
courage  sufficient  to  handle  the  knife  himself,  he  is  said 
to  have  employed  a  barber  to  do  the  dissecting,  while  he 
pointed  out  the  different  parts  with  a  rod.  Two  years 
later,  1308,  the  Senate  of  Venice,  in  defiance  of  the  decrees 
of  Pope  Boniface  \'IIT.,  enacted  a  law  allowing  one  dead 
human  body  to  be  annually  used  for  the  study  and  teach- 
ing of  anatomy. 

This  is  probably  the  first  act  of  a  legislative  body  directly 
authorizing  the  use  of  a  limited  number  of  human  bodies 


59 

for  the  purpose  of  better  qualifying  physicians  and  sur- 
geons to  alleviate  the  suffering  of  the  living.  Such,  how- 
ever, was  still  the  dread  of  incurring  the  anathemas  of 
the  Ecclesiastics,  that  we  learn  of  only  two  more  bodies 
being  used  by  Mondino  in  the  school  at  Bologna  in  131 5, 
and  none  in  the  school  at  Prague  until  1348,  in  that  at 
Montpellier  until  1376,  and  in  the  one  at  Strasbourg  until 
15 17.  During  all  the  prosperous  years  of  the  school  at 
Salernum  they  used  chiefly  the  hog  for  demonstrations  in 
anatomy. 

Mondino  de  Luzzi,  however,  industriously  wrote  de- 
scriptions of  the  parts  dissected  under  his  direction,  and 
in  1316  published  his  celebrated  work  entitled,  "Anatome 
Omnium  Humani  Corporis  Interiorum  Membrorum", 
which  served  as  a  text-book  on  human  anatomy  in  all  the 
medical  schools  during  the  next  three  centuries.  Although 
very  incomplete  and  erroneous  in  many  parts,  resulting 
from  the  hasty  and  imperfect  method  of  dissection,  it  con- 
stituted the  real  beginning  of  human  anatomy  as  one  of 
the  fundamental  branches  of  medical  science.  Mondino  was 
a  son  of  an  apothecary  of  Bologna,  and  followed  the  same 
calling  until  he  became  one  of  the  professors  in  the  medical 
school.  He  was  born  in  1276,  and  died  at  Naples  in  1326, 
where  he  was  serving  as  deputy  to  King  Robert. 

After  the  death  of  Mondino,  very  little  progress  was 
made  in  the  correction  and  development  of  human  anatomy 
until  the  beginning  of  the  sixteenth  century,  when  An- 
dreas Vesalius,  of  Brussels,  appeared  upon  the  stage 
of  action.  He  was  born  in  15 14.  His  ancestors  for,  at 
least,  three  generations  had  been  physicians.  He  received 
his  primary  education  at  Louvain,  and  studied  medicine 
in  both  Montpellier  and  Paris  with  such  success  that 
he  returned  to  his  native  city  at  the  age  of  twenty  years. 
At  Paris  he  was  under  the  instruction  of  Silvius  and  ac- 
quired an  extraordinary  zeal  for  the  study  of  anatomy. 
Near  Louvain  was  a  noted  place  for  the  execution  of  crim- 
inals, and  it  is  said  that  Vesalius  boldly  and  skillfully  stole 
some  of  his  subjects  for  dissection  directly  from  the  gal- 
lows after  their  execution.     At  the  age  of  twenty-three 


6o 

years  he  became  Professor  of  Anatomy  at  Padua,  and  sub- 
sequently gave  instruction  in  both  Pisa  and  Bologna. 

In  1543,  he  caused  to  be  published  his  remarkable  work, 
"De  Corporis  Humani  Fabrica  Libri  Septem";  illustrated 
by  excellent  wood  cuts,  drawn  from  nature  by  John  Ste- 
phan,  a  pupil  of  Titian  the  artist.  At  first  the  work 
was  met  by  violent  opposition  from  much  the  larger  number 
of  his  contemporaries,  chiefly  on  account  of  his  numerous 
and  bold  corrections  of  the  errors  in  the  anatomical  writings 
of  all  his  predecessors  from  Aristotle  to  Mondino.  His 
critics  were  simply  challenged  to  prove  their  charges  by  act- 
ual dissections.  So  far  as  they  were  induced  to  do  this 
he  was  not  only  fully  vindicated,  but  a  much  better  knowl- 
edge of  human  anatomy  was  rapidly  developed  in  all  the 
medical  schools  of  Europe.  The  same  year  that  his  great 
work  on  anatomy  was  published  (1543)  Vesalius  became 
physician  to  the  Emperor,  Charles  V.,  and  accompanied 
Ifim  in  his  campaigns  through  Belgium  and  Germany. 
About  1556,  he  became  physician  to  Philip  II.,  in  Spain. 
While  there  he  met  with  so  much  opposition  from  the  priests 
that  he  suddenly  left  on  a  pilgrimage  to  Jerusalem,  in  1563. 
Soon  after  his  arrival  in  that  city,  he  received  notice  of 
appointment  to  a  professorship  in  the  medical  school  at 
Padua.  In  returning  he  was  shipwrecked  and  he  died,  on 
the  Island  of  Zante  from  injuries  received,  at  the  age  of 
fifty  years. 

The  most  noted  anatomists  after  Vesalius  during  the 
last  half  of  the  sixteenth  century  were  Columbus,  a  pupil 
of  Vesalius,  while  at  Padua;  Eustachius,  at  Rome,  Fallo- 
pius,  of  Modena;  Fabricius,  of  Padua;  Caesalpinus,  also  of 
Padua;  and  Thomas  Vicary,  of  London,  who  published  a 
book  on  the  "True  Anatomy  of  jMan's  Body"  in  1577. 

Columbus,  who  followed  Vesalius  at  Padua,  described 
the  systole  and  diastole  of  the  heart  with  the  dilatation  and 
contraction  of  the  arteries.  He  also  pointed  out  the  fact 
that  the  blood  passed  from  the  right  side  of  the  heart  to 
the  lungs  and  returned  as  arterial  blood  through  the  pul- 
monary veins  to  the  left  side  of  the  heart,  but  he  failed  to 
comprehend  the  mechanism  of  the  circulation  of  the  blood. 


6i 

Eustachius  was  an  eminent  teacher  of  anatomy  in  Rome, 
a  defender  of  the  authority  of  Galen  as  against  VesaUus, 
and  yet  he  improved  our  knowledge  of  the  kidneys,  the 
teeth,  and  discovered  the  ducts  connecting  the  fauces  with 
the  middle  ear  to  which  his  name  is  attached. 

Fallopius,  a  native  of  Modena,  taught  anatomy  with 
great  success  both  at  Pisa  and  Padua;  and  his  name  has 
remained  attached  to  the  tubes  through  which  the  ovum 
passes  from  the  ovaries  into  the  uterus. 

Fabricius,  a  native  of  Aquapendente,  was  a  pupil  of 
Fallopius  and  succeeded  him  as  teacher  of  anatomy  at 
Padua.  He  described  more  fully  the  valves  in  the  veins, 
and  by  an  extensive  investigation  of  the  progress  of  em- 
bryology in  animals  he  made  important  additions  to  the 
previous  knowledge  concerning  the  development  of  the  foe- 
tus and  its  membranes,  as  seen  in  his  work  "De  Formato 
Foetu." 

Until  the  times  of  Fabricius  and  Caesalpinus  dissections 
were  made  with  the  razor,  but  that  instrument  of  the  bar- 
ber now  gave  place  to  the  scalpel  and  many  other  improved 
facilities  for  making  anatomical  demonstrations,  and  skilled 
artists  furnished  excellent  cuts  and  engravings  to  illus- 
trate their  works. 

Thus  at  the  close  of  the  sixteenth  century  simple  de- 
scriptive anatomy  had  reached  a  degree  of  development 
entitling  it  to  recognition  as  a  distinct  department  of  med- 
ical science. 

Chemistry:  The  origin  and  progressive  development 
of  chemistry  as  a  science  presents  a  most  interesting  field 
for  study.  The  name  chemistry  is  supposed  to  have  been 
derived  from  Chemia,  the  original  name  of  Egypt,  and  was 
called  the  "Egyptian  Art",  on  the  supposition  that  it  origi- 
nated in  that  country.  The  truth  is,  however,  that  all  of  the 
ancient  nations  and  tribes  were  possessed  of  some  chemical 
facts  and  processes  gained  by  simple  empirical  observation 
and  experience.  Thus  the  Egyptians  early  acquired  con- 
siderable skill  in  smelting  ores,  working  metals,  and  in 
making  dyes  for  coloring.  The  Hebrews  were  well  ac- 
quainted with  gold,  silver,  copper,  tin,  lead  and  iron,  and 


62 

many  of  their  uses.  And  the  Phoenicians  were  skilled  in 
dyeing,  making  glass,  pottery,  etc.  There  is  no  evidence, 
however,  that  any  of  these  people  had  any  knowledge  of  the 
elementary  composition  of  the  substances  they  handled,  or 
of  the  laws  governing  their  combinations.  But  the  same 
mental  tendencies  which  had  caused  them  to  assume  that 
the  world  was  made  of  the  four  elements,  fire,  air,  water 
and  earth,  led  them  to  assume  that  all  the  various  metals 
were  made  of  sulphur  and  mercury,  and  as  early  as  the 
fourth  century  A.  D.,  the  idea  of  converting  the  less  valuable 
metals  into  the  more  valuable,  as  silver  and  gold,  began 
to  be  discussed  by  the  Eg}'ptians  and  Greeks.  The  same 
problem  was  communicated  to  the  Arabians  during  their 
invasions  of  Eg}'pt  in  the  seventh  century  A.  D.,  and  from 
that  time  its  solution  became  an  absorbing  passion  with  the 
educated  classes  during  all  the  succeeding  eight  centuries. 

The  theory  on  which  their  investigations  were  based 
was  that  mercury  was  the  fixed  or  undecomposable  metal 
that  imparted  lustre  and  malleability  to  all  the  other  metals ; 
while  sulphur  was  thought  to  be  decomposable  and  liable 
to  many  adulterations.  All  the  metals  were  supposed  to  be 
composed  of  these  two  in  different  proportions  and  in  differ- 
ent degrees  of  purity.  This  view  was  doubtless  strengthened 
by  the  fact  that  iron,  copper,  lead,  etc.,  were  generally  found 
in  their  native  ores  in  combination  with  sulphur. 

As  was  stated  when  discussing  the  Arabian  era  of  med- 
icine, all  those  who  embraced  the  foregoing  theory  were 
called  Alchemists  or  searchers  for  the  philosopher's  stone 
that  was  supposed  to  be  capable  of  converting  all  the  baser 
metals  into  silver  and  gold.  A  large  proportion  of  them 
were  medical  men,  among  whom,  Geber,  the  Arabian,  was 
one  of  the  most  eminent.  By  his  experiments  he  learned 
how  to  convert  metals  into  oxides  by  heat ;  how  to  purify 
native  sulphur;  and  how  to  make  alum,  saltpetre,  sal-am- 
moniac and  green  vitriol.  He  and  his  pupils  also  gave  a 
good  account  of  the  carbonates  of  the  fixed  alkalies ;  of 
sulphuric  acid  as  obtained  by  distillation  of  alum ;  of  nitric 
acid  by  distilling  saltpetre  and  green  vitriol ;  of  acetic  acid 
from  vinegar ;  and  of  alcohol  from  wine.     With  their  acids 


63 

they  made  several  salts,  the  most  important  of  which  were 
nitrate  of  silver  and  bichloride  of  mercury.  Geber  pub- 
lished a  work  on  the  construction  of  chemical  furnaces  and 
other  apparatus. 

The  Arabians  thus  made  a  substantial  beginning  in 
chemistry  between  the  eighth  and  twelfth  centuries  A.  D. 
Following  them  in  the  thirteenth  century  were  such  leaders 
as  Albertus  Magnus,  in  Germany,  Roger  Bacon,  in  Eng- 
land, and  Raymond  Lully,  in  Italy.  They,  however,  added 
but  little  to  what  had  been  accomplished  by  Geber  and  his 
followers  in  Arabia. 

Bacon  was  popularly  known  as  "Dr.  Mirabilis",  and 
Lully  as  "Dr.  Illuminatissimus."  The  latter  finally  joined 
the  Franciscan  frairs  and  went  as  a  missionary  to  Africa, 
where  he  was  killed  by  the  Saracens. 

During  the  fourteenth  century  the  doctrines  of  the  Al- 
chemists became  thoroughly  diffused  throughout  Europe, 
and  were  embraced  by  many  of  the  monks  and  priests  not- 
withstanding the  formal  edict  forbidding  it,  issued  by  Pope 
John  XXII.,  in  1317  A.  D. 

Among  the  most  noted  of  these  was  Basil  Valentine, 
during  the  last  half  of  the  fifteenth  century.  He  was  a 
Benedictine  monk  of  Erfurt,  and  is  credited  with  having 
discovered  antimony;  of  making  some  qualitative  analyses, 
and  of  having  used  some  preparation  of  antimony  in  the 
treatment  of  diseases.  He  also  represented  common  salt 
(chloride  of  sodium)  as  a  third  elementary  metal. 

Up  to  the  commencement  of  the  sixteenth  century  all 
medical  teaching  in  the  schools  and  universities  of  Europe 
was  conducted  in  the  Latin  language,  and  adhered  tena- 
ciously to  the  leading  doctrines  of  Hippocrates  and  Galen. 
Notwithstanding  this,  and  the  repressing  influence  of  the 
edicts  of  Popes  and  Ecclesiastical  Councils,  a  spirit  of  re- 
bellion or  independence  of  thought  and  action  became  vis- 
ible during  the  fourteenth  and  fifteenth  centuries.  Early  in 
the  sixteenth  century  that  spirit  broke  forth  as  a  meteor,  in 
the  person  of  Theophrastus  Bombast  von  Hohenheim,  usu- 
ally called  Paracelsus.  He  was  born  in  1493,  near  Maria 
Einsiedeln,  in  Switzerland.     He  received  his  primary  edu- 


64 

cation  under  the  direction  of  his  father,  who  was  also  a  prac- 
tising physician.  At  the  age  of  sixteen  years  he  entered 
the  University  of  Basil,  where  he  enjoyed  the  use  of  the 
laboratory  of  Sigmund.  On  leaving  the  University  he  en- 
gaged as  an  army  surgeon  in  the  Venetian,  Danish  and 
Netherland  wars ;  and  subsequently  travelled  extensively 
through  Spain,  Portugal,  Prussia,  Denmark,  Egypt  and 
the  Orient,  as  he  said,  '"in  order  to  understand  the  wonders 
of  nature,"  for  he  declared  that,  "Reading  never  made  a 
doctor,  but  practise  is  what  forms  the  physician." 

At  the  age  of  thirty-two  years  he  returned  to  Germany, 
and  engaged  in  the  general  practise  of  his  profession.  His 
success,  coupled  with  an  unusual  independence  of  expres- 
sion, soon  gained  for  him  a  good  reputation,  and  in  1527 
he  was  given  a  professorship  at  Basil  with  a  liberal  salary. 
But  regardless  of  the  universal  custom  of  teaching  in  Latin, 
he  gave  all  his  instruction  in  the  language  of  his  own  coun- 
try, the  German. 

He  also  indulged  in  violent  denunciation  of  the  author- 
ity of  Galen  and  Avicenna,  and  is  represented  to  have  pub- 
licly made  a  bonfire  of  their  works.  These  acts  soon  in- 
volved him  in  controversies  so  extensive  and  bitter  as  to 
compel  him  to  leave  his  position  in  the  University.  He 
then  became  an  itinerant  practitioner  and  teacher,  and  by 
lecturing  and  writing  in  the  native  language  of  the  coun- 
try he  everywhere  attracted  followers,  and  by  the  energy 
of  his  assaults  upon  all,  so-called,  established  authorities, 
he  compelled  even  his  adversaries  to  exercise  more  inde- 
pendence of  thought  and  expression  in  their  own  defence. 
He  also  aided  much  in  turning  the  attention  of  the  Alchem- 
ists from  the  transmutation  of  metals  to  the  discovery  of 
new  remedies  for  the  treatment  of  diseases.  He  even 
boasted  of  having  discovered  a  universal  remedy  called  the 
"Elixir  of  Life."  Nevertheless  he  died  from  the  combined 
effects  of  poverty,  dissipation  and  disease,  at  the  early  age 
of  forty-eight  years. 

During  the  last  part  of  the  sixteenth  century  the  ex- 
treme pretensions  of  the  Alchemists  began  to  be  opposed 
by  Libavius  and  Van  Helmont.     The  former  was  a  phy- 


65 

sician  of  Cobtirg,  who  improved  the  processes  for  making 
sulphuric  acid  and  made  a  preparation  of  bichloride  of  tin, 
which  is  still  called  the  fuming  liquor  of  Libavius.  Van 
Helmont  boldly  denied  the  four  elements  of  the  ancients, 
claiming  that  fire  was  not  a  substance.  He  equally  denied 
that  the  elements  of  the  Alchemists,  sulphur,  mercury  and 
salt,  were  elements  of  either  animal  or  vegetable  bodies, 
and  in  their  place  he  put  forth  the  claim  that  water  was 
the  cTiief  element  of  all  things.  To  demonstrate  the  cor- 
rectness of  this  claim  he  planted  a  willow,  weighing  only 
five  pounds,  in  a  pot  filled  with  earth,  and  for  five  years 
gave  it  nothing  but  water  and  air.  At  the  end  of  ^he  time 
the  willow  weighed  one  hundred  and  sixty-four  pounds, 
while  the  earth  in  the  pot  had  only  lost  two  ounces.  He 
described  several  gases,  and  appears  to  have  been  the  first 
to  use  the  word  gas  to  designate  a  chemical  product. 

The  sixteenth  century  thus  closed  with  some  real  chem- 
ical progress,  and  the  adoption  of  some  true  methods  of 
investigation,  though  the  bitter  controversies  between  the 
followers  of  Paracelsus  and  the  persistent  defenders  of  the 
ancient  Greek  and  Roman  authorities  were  at  the  height 
of  their  activity. 

Progress  in  the  other  departments  of  medicine,  during 
the  three  centuries  under  review,  was  less  than  in  anatomy 
and  chemistry.  But  the  revival  of  the  study  of  human 
anatomy  and  the  constant  demand  for  operative  surgery 
caused  by  the  frequent  wars,  certainly  led  to  many  im- 
provements in  the  departments  of  both  surgery  and  mid- 
wifery. In  the  Italian,  and  indeed  all  the  medical  schools 
of  Europe,  during  these  centuries  anatomy,  surgery  and 
operative  midwifery  were  taught  by  the  same  person.  Con- 
sequently, the  most  eminent  anatomists  were  generally 
found  among  the  most  active  surgeons. 

For  a  long  time  a  warm  controversy  was  maintained 
concerning  the  question  whether  the  dressing  of  surgical 
and  other  wounds  should  be  wet,  as  advised  by  Hippocrates, 
or  dry,  as  suggested  by  Galen.  The  disciples  of  the  school 
at  Salernum  followed  the  former,  and  those  of  the  school 
at  Bologna  adhered  to  Galen.     The  same  question  was  again 


66 

persistently  discussed  in  some  of  the  medical  journals  only 
a  few  years  since. 

Besides  those  who  used  wet,  relaxing  dressings  (poul- 
tices), there  were  many  who  used  soothing  ointments;  and 
those  more  directly  connected  with  the  armies  used  wine 
and  oil,  aided  by  a  covering  of  wool.  As  nearly  all  the 
educated  physicians  were  of  the  order  of  the  Priesthood, 
and  persistently  forbidden  to  shed  human  blood,  practical 
surgery  was  so  long  compelled  to  remain  in  the  hands  of 
barbers  and  less  educated  persons,  that,  coincident  with 
the  revival  of  anatomy  and  the  multiplication  of  medical 
schools,  the  more  intelligent  barber  surgeons  began  to  de- 
mand a  better  recognition  in  the  schools  and  a  more  equal 
standing  with  physicians.  In  France,  before  the  close  of 
the  thirteenth  centurj^  under  the  leadership  of  Jean  Pitard, 
royal  surgeon  to  St.  Louis,  the  reigning  monarch,  an  asso- 
ciation of  the  better  educated  surgeons  was  formed  under 
the  name  of  "College  de  Saint  Como."  This  organization 
claimed  a  board  of  examiners,  and  established  a  respect- 
able standard  of  education  for  admission,  including  a  knowl- 
edge of  Latin,  the  study  of  medicine  and  philosophy  in  a 
university  two  years,  and  the  study  of  surgery  two  years 
more.  The  College  of  St.  Como,  thus  organized,  was  sus- 
tained until  1713,  when  it  was  merged  into  the  "Academie 
de  Chirurgie",  and  exerted  much  influence  in  elevating  the 
condition  of  surgery,  especially  in  France. 

Early  in  the  fourteenth  century  the  more  intelligent 
barber  surgeons  of  London,  England,  under  the  leadership 
of  Thomas  Vicary,  formed  an  association  or  guild  for  sim- 
ilar purposes,  which  became  a  chartered  organization  in 
1461,  under  the  title  of  "Masters  of  the  Commonality  of 
Barbers  of  London." 

A  similar  organization  was  formed  in  Hamburg  in  1452. 

By  all  the  foregoing  influences  the  practice  of  surgery 
was  being  gradually  elevated  to  a  higher  educational  plane, 
while  the  introduction  of  dissections  of  the  human  body 
for  the  study  of  anatomy  in  nearly  all  the  medical  schools 
compelled  greater  familiarity  with  it  by  physicians,  and  in- 
clined a  larger  number  of  them  to  practise  surgery  as  well 


^7 

as  medicine.  Thus  the  two  classes  of  medical  practitioners 
were  being  drawn  nearer  together. 

During  the  last  years  of  the  thirteenth  century  Lan- 
franchi,  of  Milan,  a  surgeon  well  educated  in  the  Italian 
schools,  accepted  membership  in  the  College  de  St.  Como" 
at  Paris,  and  gave  lectures  that  were  attended  by  large  num- 
bers of  students.  He  published  a  work  on  both  Major  and 
Minor  Surgery,  in  which  he  advocated  the  free  use  of  the 
actual  cautery,  but  showed  much  timidity  in  the  use  of  the 
knife.  He  was  followed,  in  the  early  part  of  the  fourteenth 
century,  by  Guy  de  Chauliac,  who  studied  medicine  at  Paris, 
IMontpellier,  and  Bologna,  and  became  chaplain  and  phy- 
sician of  Pope  Urban  V.  Subsequently  he  practised  many 
years  at  Lyons.  While  Chaplain  of  the  Pope  at  Avignon, 
1363,  he  published  an  important  work  known  as  the  "Chi- 
rurgia  Magna",  which  was  accepted  as  the  ruling  surgical 
authority  for  many  years  throughout  France.  This  work 
though  containing  very  little  that  is  new  or  original,  con- 
tains a  very  fair  statement  of  surgical  views  and  prac- 
tices at  the  time  it  was  written,  with  less  intermixture  of 
purely  fanciful  dogmas  than  in  previous  works.  He  rec- 
ommended venesection  according  to  the  location  and  nature 
of  the  disease ;  opened  freely  fistulous  tracts  and  deep-seated 
abscesses ;  and  applied  the  actual  cautery  for  caries,  an- 
thrax and  open  cancerous  and  leperous  cases.  He  gives 
very  fair  directions  for  the  treatment  of  dislocations,  frac- 
tures, and  surgical  diseases  of  the  eyes.  He  relates  cases 
of  trepanning,  lithotomy,  the  removal  of  pharyngeal  polypi, 
and  the  removal,  by  amputation,  of  supernumerary  limbs. 
He  endeavors  to  so  adjust  wounded  surfaces  as  to  favor 
union  by  first  intention,  and  arrests  haemorrhage  by  styp- 
tics and  pressure  when  possible,  applying  actual  cautery  only 
in  bad  cases. 

During  the  third  quarter  of  the  fourteenth  century, 
John  Ardern,  an  English  surgeon,  who  practised  first  in 
Newark  and  subsequently  in  London,  gained  considerable 
reputation  for  the  treatment  of  "Fistula  in  Ano",  and  left 
a  chapter  in  manuscript  on  the  subject,  which  was  pub- 
lished by  John  Read  in  1588. 


68 

The  man  who  is  credited  with  having  accompUshed  most 
for  the  advancement  of  surgery  during  the  sixteenth  cen- 
tury, was  Ambroise  Pare,  bom  at  Laval,  about  1510.  He 
commenced  his  career  as  an  apprentice  to  the  provincial 
barber  surgeons,  but  feeling  the  need  of  better  training,  at 
the  age  of  22  years,  he  went  to  Paris,  and  studied  three 
years  at  the  Hotel  Dieu.  He  made  such  progress  as 
to  gain  the  confidence  and  special  commendation  of  his 
teachers,  and  in  1537  he  was  made  surgeon  to  Colonel 
Rene  de  Montijean,  and  accompanied  him  in  his  first  cam- 
paign in  Italy.  This  campaign,  which  continued  three 
years,  furnished  the  opportunity  that  enabled  him  to  make 
one  of  his  most  important  improvements  in  practical  sur- 
gery. Until  his  time,  gun-shot  wounds  had  been  univer- 
sally regarded  as  poisoned  and  burned  by  the  penetrating 
ball  or  missile  and  burning  powder,  and  were  treated  by 
pouring  into  them  boiling  oil  or  by  the  application  of  actual 
cautery,  thereby  adding  immensely  to  the  torture  of  the 
patients.  Early  in  the  progress  of  the  campaign  he  found 
himself  in  charge  of  a  large  number  of  wounded  soldiers, 
and  his  supply  of  boiling  oil  became  exhaused  with  many 
wounds  still  without  that  dressing.  After  passing  a  sleep- 
less night  from  anxiety  he  w^as  surprised  to  find  in  the  morn- 
ing that  the  patients  who  had  received  no  oil  in  their 
wounds  had  suffered  much  less  and  were  in  better  condi- 
tion than  those  to  whose  wounds  it  had  been  applied.  This 
led  him  to  reflection  and  further  trials  ending  in  his  aban- 
donment of  the  use  of  the  boiling  oil  as  a  dressing,  and  also 
the  doctrine  that  such  wounds  were  necessarily  either  pois- 
oned or  burned. 

After  the  close  of  this  campaign,  he  returned  to  Paris 
and  was  married.  In  1543  he  again  entered  military  ser- 
vice with  the  army,  in  the  service  of  de  Rohan,  Lord  of 
Brittany,  during  which  he  added  much  to  his  reputation  by 
boldly  resorting  to  the  ligation  of  arteries  for  the  arrest  of 
haemorrhage  instead  of  the  actual  cautery.  After  his  re- 
turn from  another  active  campaign  he  was  appointed  one 
of  the  twelve  royal  surgeons,  and  in  1554  he  was  elected 
fellow  of  the  College  de  St.  Como,  against  their  rule  re- 


69 

quiring  a  knowledge  of  Latin;  for  Pare  never  acquired  a 
knowledge  of  the  Latin  language,  but  wrote  all  his  works 
in  the  language  of  his  own  country — France.  In  1545,  he 
wrote  his  first  notable  work  on  the  treatment  of  gun-shot 
and  other  wounds,  and  of  burns  by  gun  powder.  It  was  a 
small  volume  in  French,  published  by  Gaulterot,  the  book- 
seller of  the  University  of  Paris,  and  soon  brought  about 
a  most  desirable  revolution  in  the  treatment  of  such  wounds. 

Subsequently  he  became  surgeon  to  King  Henry  II.,  and 
directly  after  this  monarch's  death,  in  1559,  he  occupied 
the  same  relation  successively  to  Francis  II.,  and  to  Charles 
IX. 

In  1573  he  caused  to  be  published  his  important  work 
entitled  "Deux  Livres  de  Chirurgie",  in  which  is  shown  the 
work  of  a  most  active  and  practical  mind,  constantly  striv- 
ing to  make  such  improvements  as  would  lessen  human 
suffering  and  prolong  human  life,  and  yet  keeping  nothing 
secret  for  private  gain  as  was  much  the  practice  in  his  day. 
For  during  those  centuries,  many  went  from  place  to  place 
claiming  to  have  discovered  some  valuable  elixir,  or  some 
special  mode  of  operation,  and  called  themselves  Herniot- 
omists,  Lithotomists,  etc.,  much  like  some  of  the  peram- 
bulating specialists  of  the  present  day. 

Pare,  though  rising  from  the  humble  condition  of  a 
poor  barber  surgeon's  apprentice  to  that  of  chief  surgeon 
of  a  kingdom,  and  the  honored  guest  of  many  kings,  ever 
remained  true  to  his  early  maxim  that :  "He  who  becomes  a 
surgeon  for  the  sake  of  money,  and  not  for  the  sake  of 
knowledge,  will  accomplish  nothing."  He  was  not  only 
ever  seeking  knowledge,  but  also  persistently  applying  it 
in  improving  instruments  and  modes  of  operation,  the  correc- 
tion of  errors,  and  the  abandonment  of  evil  practices  though 
sanctioned  by  all  preceding  authorities.  Actuated  T)y  such 
motives  and  aided  by  Lanfranchi,  of  Milan;  Maggi,  of 
Bologna;  Lange,  of  Germany,  and  others,  he  lived  to  see 
surgery  fairly  started  on  a  career  of  independent  profes- 
sional recognition  and  progress.  He  died  in  1590,  aged 
about  80  years. 

In  close  connection  with  the  progress  of  anatomy  and 


surgen-,  during  the  sixteenth  century,  came  the  beginning 
of  pathological  anatomy. 

During  the  last  part  of  the  fifteenth  century  Benivieni, 
of  Florence,  commenced  searching  for  the  seat  and  nature 
of  diseases  and  the  causes  of  death  by  post-mortem  examina- 
tions of  bodies,  whenever  practicable.  The  results  of  his 
work  were  published  at  Florence,  in  1507,  in  a  monograph 
with  the  title  "Concerning  Some  of  the  Secret  and  Strange 
Causes  of  Disease" ;  in  which  he  describes  the  gross  patho- 
logical conditions  found,  and  the  chief  symptoms  with  which 
they  were  connected  during  life.  He  was  followed  in  the 
same  field  of  investigation  by  Donatus,  Grafenberg,  Felix 
Patter,  Fernel,  Koyster,  and  others.  The  descriptions  of 
changes  found  by  the  latter  in  the  brain  and  spinal  cord 
after  death  from  delirium,  convulsions  and  paralysis  were 
remarkable  for  their  minuteness  and  general  accuracy.  As 
the  result  of  the  investigations  of  this  class  of  workers, 
extending  through  the  whole  of  the  sixteenth  century,  the 
profession  was  made  acquainted  with  a  great  variety  of  mor- 
bid conditions  in  the  internal  structures  and  organs,  re- 
sulting from  diseases  both  acute  and  chronic. 

Thus  was  laid  the  foundation  of  pathological  anatomy 
by  direct  personal  research,  and  not  a  few  of  the  theoretical 
dogmas  of  the  ancients  were  corrected  and  the  way  pre- 
pared for  entering  the  field  of  physiology  in  the  next  cen- 
tury. 

In  the  surgical  part  of  midwifery  the  Csesarean  section 
and  podalic  version  were  revived  and  improved  by  Pare, 
Guillemeau  and  Rousset;  and  in  the  field  of  practical  med- 
icine the  chief  advancements  were  in  the  better  recognition 
of  syphilitic  and  gonorrheal  affections ;  the  use  of  mer- 
curials externally  and  internally;  the  revival  and  more  dis- 
criminating practice  of  venesection,  especially  in  acute  in- 
flammatory' diseases ;  and  a  marked  increase  of  independent 
individual  thought  and  practice. 

The  frequent  recurrence  of  epidemics  of  the  plague, 
small-pox  and  other  diseases  mentioned  at  the  close  of  the 
preceding  chapter,  continued  with  little  or  no  abatement 
through  the  fourteenth,  fifteenth  and  sixteenth  centuries; 


to  which  were  added  during  the  last  named  century  epidemic 
influenza,  or  la  grippe,  petechial  or  spotted  typhus,  and 
pleuro-pneumonia. 


72 


CHAPTER  VI. 

HISTORY  OF  PROGRESS  IX  THE  DEVELOPMENT  OF  THE  VARIOUS 

BIL\NCHES  OF   MEDICAL   SCIENCE  AND   EDUCATION 

DURING  THE  SEVENTEENTH  CENTURY  A.  D. 

In  the  preceding  chapter  chief  attention  was  given  to  the 
origin  and  development  of  the  two  fundamental  branches  of 
medical  science,  i.  e.,  human  anatomy  and  chemistry. 

The  three  centuries  of  progress  reviewed  in  that  chap- 
ter constituted  a  transition  period  of  great  importance.  It 
marked  the  emergence  of  the  human  mind  from  the  domain 
of  purely  speculative  fancies,  called  philosophy,  and  tena- 
cious obedience  to  authority,  to  the  actual  study  and  colla- 
tion of  facts  from  which  to  deduce  conclusions,  and  the 
institution  of  experimental  tests  instead  of  the  dictum  of 
authority.  It  is  true  the  emergence  was  slow,  and  char- 
acterized by  mental  controversies  as  bitter  and  relentless 
as  the  coincident  political  contests  and  almost  continuous 
wars  that  devastated  the  greater  part  of  Europe. 

When  schools  of  medicine  and  of  other  branches  of 
learning  were  re-established  in  Europe  on  the  decline  of 
the  Arabian  era  they  were  still  founded  on  essentially  the 
same  theoretical  dogmas  that  had  pervaded  all  the  systems 
of  Grecian  and  Roman  philosophy.  So  persistent  was  this 
reverence  for  authority  that  when,  at  the  commencement 
of  the  fourteenth  century,  Frederick  II.,  King  of  Naples,  re- 
quired all  who  would  practise  medicine  in  his  kingdom  to 
be  examined  by  the  Faculty  of  Salernum,  the  works  on 
which  they  were  to  be  examined  were  those  of  Hippocrates, 
Galen  and  Avicenna.  And  a  century  later,  when,  under 
the  leadership  of  such  men  as  Nicholas  Leonicenus,  of 
Italy,  and  Thomas  Linacre,  of  England,  the  study  of  Greek 
language  and  literature  had  been  revived  and  the  best  clas- 
sical authors  had  been  translated  into  excellent  Latin,  the 
last  named  author,  by  the  authority  of  King  Henr>'  VIII., 
was  permitted  to  establish  chairs  of  Hippocratic  and  Galen- 
ical Medicine  in  the  Universities  of  Oxford  and  Cambridge, 


73 

and  ail  medical  writing  and  teaching  was  done  in  the  Latin 
language.  While  this  persistent  submission  to  the  dictum 
of  authority,  often  sustained  by  the  edicts  of  kings,  popes, 
and  ecclesiastical  councils,  w^as  exhibited  on  one  side;  on 
the  other  was  the  inherent  principle  implanted  in  the  human 
mind  constantly  prompting  to  independence  of  thought  and 
action,  aided  by  the  fundamental  doctrine  of  the  Christian 
religion,  i.  e.,  man's  individual  responsibility  to  God,  as  pro- 
mulgated by  its  divine  author  and  his  immediate  followers. 
It  was  the  promptings  of  the  latter  principles  and  doctrines 
that  led  such  men  as  Mondino,  Vesalius,  and  their  followers, 
to  study  human  anatomy  in  defiance  of  the  highest  human 
authority,  when  the  only  apparent  benefits  to  accrue  were 
the  personal  satisfaction  always  afforded  by  increased 
knowledge  and  the  higher  satisfaction  of  so  applying  it  as 
to  greatly  benefit  the  living. 

It  was  the  same  promptings  that  caused  Geber,  the 
Arabian,  Basil  Valentine  and  other  monks,  Paracelsus,  and 
especially  Libavius  and  Van  Helmont,  to  so  guide  the  zeal- 
ous labors  of  the  alchemists  as  to  develop  not  only  new 
chemical  substances,  but  also  a  knowledge  of  the  applica- 
tion of  such  substances  in  the  treatment  of  disease.  The 
persistence  of  authority  in  making  Latin  the  language  of 
medicine,  both  in  writing  and  teaching,  was  rudely  shocked 
by  the  rebellious  course  of  Paracelsus  in  boldly  writing  and 
teaching  in  his  native  German;  and  its  influence  was  still 
more  effectually  nullified  by  the  quiet  and  dignified  course 
of  Ambroise  Pare  in  his  adherence  to  his  native  French 
throughout  his  long  and  successful  career. 

Renouard  and  other  historical  writers  have  designated 
the  period  intervening  between  the  re-establishment  of  med- 
ical schools  in  Europe,  and  the  end  of  the  sixteenth  cen- 
tury, as  an  "Age  of  Renovation."  Perhaps  it  might  be  more 
properly  called  a  protracted  period  of  mental  revolution, 
durmg  which  the  human  mind  slowly  but  successfully 
emerged  from  its  bonds  of  authority,  both  philosophical 
and  ecclesiastical,  and  asserted  its  own  right  to  independence 
of  thought  and  of  expression.  And  the  seventeenth  cen- 
tury, instead  of  being  a  period  of  reform  (Renouard)  was 


only  a  continuance  and  increase  of  that  independent  spirit 
of  investigation  which  had  already  begun  to  manifest  itself 
among  the  students  in  every  department  of  human  knowl- 
edge. For  it  was  during  the  last  part  of  the  sixteenth 
century  that  Copernicus,  Kepler,  Galileo,  and  their  co-work- 
ers, laid  the  foundations  for  nearly  all  the  modern  physical 
and  natural  sciences.  And  during  the  seventeenth  cen- 
tury their  work  was  greatly  extended  by  Swammerdam, 
Hooke,  Malpighi,  Sir  Isaac  Newton,  Romer,  James  Greg- 
ory, and  others. 

Human  investigations  having  thus  fairly  passed  from  the 
domain  of  closet  speculation  to  the  broader  field  of 
observation,  verification  by  experiment,  collection  of  facts, 
and  logical  deductions  therefrom,  greater  advancement  was 
made,  not  only  in  medicine  but  in  all  the  collateral  sciences, 
in  a  single  century  than  in  all  the  fifteen  centuries  preced- 
ing it. 

Notwithstanding  the  marked  advancements  made  in  our 
knowledge  of  chemistry,  descriptive  anatomy,  and  even 
pathological  anatomy  during  the  sixteenth  century,  com- 
paratively little  progress  was  made  in  physiology,  or  a 
knowledge  of  the  functions  of  the  various  structures  and 
organs  of  the  human  body.  Indeed  such  progress  was 
not  practicable  so  long  as  the  arteries  were  supposed  to 
carr}-  only  air  or  vital  spirits,  and  the  whole  mechanism  of 
the  circulation  of  the  blood  was  a  profound  mystery.  It  is 
true  that  in  prosecuting  the  study  of  the  anatomy  of  the 
heart  and  blood-vessels,  Fabricius  had  described  the  valves 
in  the  veins,  and  Columbus  those  of  the  heart,  and  ]\Iichael 
Servetus  and  Caesalpinus  had  explained  the  passage  of  the 
blood  through  the  lungs,  thereby  paving  the  way  for  the 
discovery  and  complete  demonstration  of  the  circulation  of 
the  blood  by  William  Harvey,  early  in  the  seventeenth 
century. 

William  Harvey  was  born  at  Folkestone,   Kent,  Eng- 

\^  land,  April   i,   1578.     His  primary  education   was   in  the 

'  grammar  school  of  Canterbury,  and  at  the  age  of  fifteen 

he  entered  Cambridge.      After    completing  his  course  in 

college  he  went  to  Padua,  in  1599,  where  he  pursued  the 


75 

study  of  medicine  five  years,  as  the  pupil  of  Fabricius  ab 
Aquapendente  and  Casserio,  and  returned  to  England  at  the 
age  of  twenty-six  years.  Soon  after  his  return  he  married 
the  daughter  of  Dr.  Lancelot  Browne,  and  received  his  first 
official  appointment  as  physician  to  St.  Bartholomew's  Hos- 
pital in  London,  in  1609,  and  as  professor  of  Anatomy  and 
Surgery  in  the  College  of  Physicians,  in  161 5.  He  engaged 
actively  in  the  practise  of  medicine  in  London,  and  annu- 
ally lectured  to  a  class  of  students  in  the  College  of  Phy- 
sicians, to  whom  he  began  to  explain  his  views  concerning 
the  functions  of  the  heart  and  the  general  circulation  as 
early  as  16 16. 

He  continued  his  investigations  several  years  longer,  ex- 
perimenting on  both  cold  and  warm  blooded  animals,  dur- 
ing which  time  he  found  neither  air  nor  "vital  spirits"  either 
in  the  arteries  or  any  cavity  of  the  heart.  He  did,  how- 
ever, clearly  prove  "that  the  blood  passes  through  the  lungs 
"and  heart  by  the  pulsation  of  the  ventricles,  and  is  sent 
"for  distribution  to  all  parts  of  the  body,  where  it  makes 
"its  way  into  the  veins  and  pores  of  the  flesh,  and  then 
"flows  by  the  veins  from  the  circumference  on  every  side  to 
"the  center,  from  the  lesser  to  the  greater  veins,  and  is 
"by  them  finally  discharged  into  the  vena  cava  and  right 
"auricle  of  the  heart,  and  this  in  such  quantity,  or  in  such 
"a  flux  and  reflux,  thither  by  the  arteries,  hither  by  the 
"veins,  as  cannot  possibly  be  supplied  by  the  ingesta,  and  is 
"much  greater  than  can  be  required  for  mere  purposes  of 
"nutrition;  it  is  absolutely  necessary  to  conclude  that  the 
"blood  in  the  animal  body  is  impelled  in  a  circle."  Having 
thus,  with  great  patience  and  perseverance,  solved  the  prob- 
lem of  the  circulation,  both  pulmonary  and  systemic,  and 
the  true  function  of  the  heart,  he  gave  a  full  account  of 
his  great  discovery  in  his  work  entitled,  "Exercitatio  Ana- 
tomica  de  IMortu  Cordis  et  Sanguinis  in  Animalibus",  pub- 
lished at  Frankfort-on-the-jMain,  1628;  the  same  having 
been  rejected  by  the  book  publishers  of  London. 

A  second  treatise  on  the  same  subject,  written  in  reply 
to  the  criticisms  of  Riolan,  of  Paris,  was  published  at  Cam- 
bridge, in   1649.       The  announcement  of  a  physiological 


7(5 

discovery  of  such  paramount  importance  and  so  antagonistic 
to  several  of  the  most  cherished  doctrines  of  all  the  past 
centuries,  did  not  fail  to  elicit  prompt  and  severe  criticism 
from  almost  every  quarter.  This,  however,  only  impelled 
the  more  earnest  of  his  opponents,  both  in  England  and 
on  the  Continent,  to  actively  investigate  the  subject,  and 
in  doing  so  they  were  soon  compelled  to  acknowledge  the 
general  correctness  of  his  views  and  to  cease  their  oppo- 
sition. 

Harvey  was  made  physician  extraordinary  to  King 
James  I.,  after  whose  death  he  became  physician  in  ordi- 
nary to  Charles  I.,  in  1632,  and  was  a  faithful  adherent  to 
that  unfortunate  monarch  during  the  war  between  him  and 
the  English  Parliament.  As  a  member  of  the  Court  he 
was  compelled  to  move  from  place  to  place,  and  on  one  occa- 
sion his  house  was  seized  and  some  valuable  manuscripts 
were  destroyed.  He  was  present  at  the  battle  of  Edge- 
hill,  after  which  he  retired  with  the  King  to  Oxford,  where 
he  was  made  Warden  of  Merton  College  and  received  the 
degree  of  M.  D.  He  remained  there  until  the  surrender  of 
the  City  to  the  Parliamentary  forces,  and  during  this  time 
he  resumed  his  studies  and  experimentation  concerning  the 
process  of  generation.  A  few  years  after  his  return  to 
London  he  gave  the  results  of  his  researches  in  a  work  en- 
titled, "Exercitationes  de  Generatione  Animalium",  pub- 
lished at  Cambridge,  in  165 1,  in  which  he  demonstrated  that 
all  animal  generation  proceeded  from  ova.  The  discovery 
of  spermatozoa,  however,  has  been  credited  to  a  German 
student,  named  Ludvig  Von  Hammen,  at  Ley  den,  in  1677. 

On  account  of  his  adherence  to  the  cause  of  the  King, 
Harvey  lost  his  position  as  physician  to  St.  Bartholomew's 
Hospital,  but  retained  his  connection  with  the  College  of 
.  Physicians  and  his  general  practice  in  the  city.  Notwith- 
standing the  severe  criticisms  of  his  great  work,  published 
in  1628,  the  opposition  subsided  as  rapidly  as  verifying  re- 
searches or  tests  could  be  instituted,  and  its  correctness,  to- 
gether with  that  of  his  subsequent  work  on  Generation,  was 
so  generally  acknowledged,  that  in  1652,  his  statue  was 
placed  in  the  Hall  of  the  College,  with  suitable  inscriptions 


77 

in  honor  of  his  discoveries.  Soon  after  this  he  built  a 
valuable  addition  to  the  Hall  and  gave  his  paternal  estate 
as  an  endowment,  accompanied  by  the  condition  that  annu- 
ally an  oration  should  be  delivered  in  commemoration  of 
the  benefactors  of  the  College,  and  containing  an  "exhorta- 
tion to  the  members  to  study  and  search  out  the  secrets  of 
nature  by  way  of  experiment,  and  for  the  honor  of  the 
profession  to  continue  mutually  in  love."  In  1654  he  was 
elected  president  of  the  College  of  Physicians,  but  on  ac- 
count of  natural  modesty  and  advanced  age,  he  declined  the 
office.  He  died  in  June,  1657,  and  was  buried  at  Hemp- 
stead, in  Essex.  His  works  were  written  in  excellent  Latin, 
the  best  translation  of  which  is  that  by  Dr.  R.  Willis,  pub- 
lished under  the  auspices  of  the  Sydenham  Society  in  1847, 

Marcello  Malpighi,  of  Crevalnore,  and  professor  in  the 
University  of  Bologna,  in  1661,  with  the  aid  of  the  micro- 
scope, discovered  the  movement  of  blood  in  the  capillaries 
of  the  lungs  and  mesentery  of  frogs,  and,  in  1665,  he  de- 
scribed the  corpuscles  of  the  blood,  the  cutaneous  glands 
and  the  pigmentary  layer  of  the  skin,  which  is  still  called 
the  "rete  Malpighii." 

In  1683,  William  Molyneux,  of  Dublin,  observed  the 
capillary  blood  currents  in  the  lizard ;  and  in  1688  Anton 
Von  Loeuwenhoeck  commenced  his  microscopic  studies  on 
the  larvae  and  feet  of  frogs,  by  which  he  was  enabled  to 
describe  the  blood  corpuscles,  both  red  and  white;  while 
William  Cowper  saw  the  arterial  blood  pass  into  the  veins. 
To  demonstrate  the  capillaries  as  the  connecting  link  be- 
tween arteries  and  veins,  Marchetti,  of  Padua,  and  sub- 
sequently Friedrich  Ruzsch,  of  Amsterdam,  succeeded  in 
minutely  injecting  them,  and  thus  completing  the  circuit  of 
blood  vessels  that  Harvey  had  declared  must  exist. 

During  the  same  period  of  time,  the  structure,  position, 
and  movements  of  the  heart  and  lungs  were  studied  by 
Nicholaus  Steno,  of  Copenhagen,  Joh.  Jac.  Harden,  of 
Basel,  Borrelli,  and  others,  by  whom  the  mechanism  of 
respiration  and  the  movements  of  the  heart  were  more  fully- 
explained. 

Following  closely  the  great  discovery  of  Harvey  regard- 


78 

ing  the  circulation  of  the  blood,  was  that  of  the  existence 
and  uses  of  lymphatic  vessels  and  glands ;  not  as  the  work 
of  one  man,  but  as  the  result  of  the  work  of  many  investi- 
gators. It  is  doubtless  true  that  Herophilus  and  Erasistra- 
uis,  in  their  study  of  comparative  anatomy,  mentioned  seeing 
white  vessels  in  the  mesentery  of  animals,  but  they  thought 
they  were  arteries  filled  with  air.  And  though  Galen 
claimed  that  the  same  vessels  contained  chyle  from  the  in- 
testine, he  supposed  they  terminated  in  the  liver.  Caspar 
Aselli,  of  Paris,  in  1622,  while  examining  the  chyliferous 
vessels  in  the  mesentery  of  a  dog  soon  after  a  full  meal, 
opened  one  of  them  by  accident,  and  saw  the  escape  of  a 
white  fluid  which  he  recognized  as  chyle  from  the  intes- 
tine. On  tracing  the  course  of  the  vessels  he  discovered 
their  valves,  but  thought  they  terminated  in  the  pancreas. 

Twenty-five  years  later  (1647),  Jean  Picquet,  at  ]\Iont- 
pellier,  traced  the  lacteal  vessels  into  the  receptaculum 
chyli,  and  the  thoracic  duct  to  its  termination  in  the  left  sub- 
clavian vein,  into  which  its  contents  were  discharged. 

The  discoveries  of  Aselli  and  Picquet  were  followed  by 
those  of  George  Jolyff,  of  Cambridge,  in  1650;  Jan  \''an 
Home,  of  Ley  den,  in  1652,  and  others,  until  the  whole  lym- 
phatic system  and  its  connection  with  the  general  circu- 
lation was  fairly  well  understood  before  the  end  of  the 
seventeenth  century. 

While  the  foregoing  investigations  were  actively  pro- 
gressing, the  publication  of  Harvey's  work  on  Generation, 
in  1 65 1,  did  not  fail  to  attract  the  attention  of  several  inves- 
tigators, chief  among  whom  were  Aubery,  of  Florence,  Jan 
Van  Home,  of  Leyden,  De  Graaf,  of  Schoonhoven,  and 
Walter  Xeedham,  in  regard  to  the  functions  of  the  ovaries 
and  the  progress  of  the  active  development  of  the  impreg- 
nated ovum  and  its  appendages.  Until  the  time  of  Harvey 
and  his  followers  the  ovaries  had  been  described  as  female 
testicles.  The  discovery  of  spermatozoa  in  the  male  semen 
by  Ludvig  Von  Hammen,  (or  Joh.  Ham,  as  he  has  been 
named  by  some  writers)  and  their  examination  by  Leuwen- 
hoeck  and  others,  first  caused  them  to  be  regarded  as  the 
real  germ  of  the  new  animal  and  endowed  with  an  immor- 


79 

tal  soul,  while  the  ovum  or  egg  of  the  female  was  looked 
upon  as  only  consisting  of  food  for  the  growth  of  the  new 
being.  But  after  much  investigation,  and  no  little  contro- 
versy, the  existence  of  a  germinal  cell  in  the  ovum  was 
demonstrated,  and  the  co-operation  of  it  with  the  sperma- 
tozoa of  the  semen  in  commencing  the  process  of  genera- 
tion was  fully  recognized. 

The  investigations  necessary  for  making  plain  the 
mechanism  of  respiration,  circulation  and  generation,  led 
to  much  additional  knowledge  of  the  anatomy  of  the  liver, 
the  pancreas,  the  mesenteric  glands  and  the  organs  of  gen- 
eration. Glisson  described  the  structure  of  the  liver  and 
its  capsule  that  took  his  name.  Anton  Nuck  first  injected 
the  lymphatics  with  quicksilver,  and  thereby  demonstrated 
their  connection  with  the  whole  system  of  lymphatic  glands. 
Thomas  Wharton,  a  professor  in  Oxford,  in  studying  the 
glands,  discovered  the  duct  of  the  submaxillary  which  took 
his  own  name;  and  Stenson  and  Needham  discovered  the 
excretory  duct  of  the  parotid  glands. 

Johann  Conrad  Peyer,  of  Schaffhausen,  and  Joh.  Conrad 
Brunner,  of  Regensburg,  discovered  the  intestinal  glands 
still  known  as  the  glands  of  Peyer  and  Brunner.  The  excre- 
tory duct  of  the  pancreas  was  discovered  by  George  Wir- 
sung,  of  Bavaria,  while  acting  as  prosector  for  Vesalius, 
at  Padua.  The  structure  of  the  testicles,  the  seminal  ducts 
and  epididymis  were  Avell  described  by  Nathaniel  High- 
more,  of  London ;  and  Walter  Needham  claimed  that  the 
foetus  in  utero  was  nourished  by  blood  from  the  placenta, 
and  he  clearly  described  the  foetal  and  maternal  parts  of 
that  organ.  It  was  near  the  middle  of  the  seventeenth 
century  that  Conrad  Victor  Schneider,  of  Saxony,  discov- 
ered the  existence  and  secretory  function  of  the  mucous 
membrane  lining  the  nostrils,  by  which  it  became  known 
as  the  Schneiderian  membrane,  and  a  final  end  was  made 
of  the  ancient  doctrine  that  discharges  from  the  nostrils 
were  humors  percolating  through  the  cribriform  plate  from 
the  brain. 

It  was  near  the  end  of  the  century,  when  Vieussens, 
professor  at  Montpellier,  who  had  previously  made  valuable 


80 

additions  to  the  knowledge  of  the  position  and  functions 
of  the  heart,  gave  a  more  complete  description  of  the  brain 
and  central  portions  of  the  nervous  system  than  had  been 
given  before ;  and  Thomas  Willis,  of  Oxford,  ordinary  phy- 
sician to  Charles  II.,  first  pointed  out  the  separate  parts 
of  the  brain  and  assigned  distinct  functions  to  each,  and 
added  much  to  the  knowledge  concerning  its  ganglia  and 
blood  vessels. 

While  the  foregoing  important  discoveries  in  physiology 
and  advancements  in  anatomy  were  developing,  the  science 
of  chemistry,  which  had  only  begun  to  assume  a  scientific 
character  during  the  sixteenth  century,  continued  to  pro- 
gress. Joh.  Rud.  Glauber,  a  contemporary  of  Van  Hel- 
mont,  early  in  the  seventeenth  century,  improved  the  pro- 
cesses for  obtaining  mineral  acids  and  salts,  and  determined 
the  composition  of  many  substances  by  synthesis.  Robert 
Boyle,  a  little  later,  by  true  inductive  methods,  showed 
that  a  substance  could  only  be  considered  as  elementary 
when  it  could  no  longer  be  separated  into  two  or  more  con- 
stituents, and  thereby  efifectually  disproved  the  long  en- 
tertained doctrine  of  the  "four  elements"  of  the  ancients. 
He  also  discovered  the  elasticity  of  the  air  and  invented  the 
air  pump.  During  the  last  part  of  the  century  Otto  Tacha- 
nius,  of  Herford,  made  the  first  correct  quantitive  analysis 
by  demonstrating  that  lead  when  converted  into  red  oxide 
gained  one-tenth  in  weight.  About  the  same  time  Nicholas 
Lemery  introduced  the  study  of  chemistry  into  Paris,  and 
was  the  first  to  demonstrate  the  existence  of  iron  in  the 
blood. 

J.  J.  Becher,  of  Speyer,  Germany,  professor  at  Ments, 
1660,  and  imperial  councillor  at  Vienna,  published  an  impor- 
tant work  to  establish  the  close  relation  between  chemistry 
and  medical  science  in  1669.  A  prominent  topic  of  dis- 
cussion was  that  of  combustion  and  oxidation,  and  it  may  be 
regarded  as  the  first  distinct  treatise  on  chemistry  as  a 
branch  of  medicine. 

Materia  Medica  :  The  marked  progress  in  physiology 
and  chemistry  during  the  seventeenth  century  was  accom- 
panied by  the  use  of  a  larger  number  of  chemical  prepara- 


8i 

tions  and  some  very  important  vegetables  as  remedies  in 
the  treatment  of  disease,  and  of  the  latter  class,  several  as 
food.  The  chemical  preparations  were  newly  discovered 
alkalies,  acids,  and  salts,  the  most  important  of  which  were 
tartar  emetic,  oxide  of  zinc,  Glauber's  salts,  and  prepara- 
tions of  mercury  and  arsenic. 

Of  the  new  vegetable  remedies  the  most  important  were 
the  cinchona  bark  and  ipecacuanha.  The  first  was  originally 
introduced  into  Europe  from  South  America,  in  1640,  by 
Juan  del  Vego,  ordinary  physician  to  the  Count  of  Cinchon. 
It  was  called  cinchona  or  "Countess'  bark"  in  honor  of  the 
wife  of  the  Count  who  had  been  cured  of  an  attack  of  fever 
by  the  remedy. 

It  was  obtained  from  the  bark  of  several  species  of 
the  cinchona  tree,  found  chiefly  in  Peru,  and  consequently 
was  later  called  Peruvian  bark.  Its  use  in  Spain  was  fav- 
ored by  the  Catholic  clergy,  and  hence  was  often  called 
"Jesuits'  "  bark.  Its  introduction  and  use  in  England  was 
greatly  promoted  by  Sydenham,  while  Robert  Tabor,  an 
apothecary  of  Cambridge,  introduced  it  as  a  secret  remedy 
into  Paris,  and  after  effecting  the  cure  of  the  Dauphin,  he 
sold  the  secret  to  the  government  of  France  for  2,000  Louis 
d'or.  In  Germany  perhaps  the  first  to  use  it  were  Peyer 
and  Professor  Valentini,  of  Giessen. 

The  first  medical  work  to  recommend  the  use  of  the 
cinchona  was  the  Vera  Praxis,  of  Pietro  Barba,  published 
at  Seville,  in  1642.  For  many  years  it  was  used  chiefly 
in  the  form  of  powder,  and  acquired  so  much  reputation  as 
a  remedy  for  the  arrest  of  malarious  fevers  that  it  some- 
times sold  for  its  own  weight  in  gold.     (Henderson.) 

Ipecacuanha  is  said  to  have  been  first  described  by  Guil- 
laume  Le  Pois,  in  1648;  and  was .  introduced  into  general 
practice  by  Le  Gras  as  a  mild  emetic  and  an  efificient  rem- 
edy for  dystentery,  in  1672.  Potatoes  first  became  a  com- 
mon article  of  food  in  Europe  in  the  seventeenth  century ; 
and  tea,  coffee  and  chocolate,  though  known  and  used  to 
some  extent  at  an  earlier  period,  rapidly  gained  wide  popu- 
larity as  articles  of  luxury  at  this  time. 

It   was   also   during  this   seventeenth   century   that   the 


82 

use  of  tobacco,  for  both  smoking  and  chewing,  increased  so 
rapidly  among  all  classes  that  several  of  the  leading  gov- 
ernments enacted  very  severe  laws  for  its  suppression. 

During  the  middle  part  of  the  same  century  the  first 
attempts  to  gain  more  accurate  knowledge  concerning  the 
action  of  drugs  by  experiments  on  living  animals  were  made 
by  Wepfer,  Brunner  and  Harder. 

State  Medicine  or  ]Medical  Jurisprudence:  This 
important  department  first  began  to  attract  special  atten- 
tion at  the  beginning  of  the  seventeenth  century.  Fortu- 
natus  Fidelis,  at  Palermo,  published  his  work,  "De  Rela- 
tionibus  Medicorum",  in  1602 ;  and  Paolo  Zacchias,  ordinary 
physician  to  the  Pope,  published  his  work,  "Questiones 
IMedico-Legales",  at  Rome,  in  162 1.  The  latter  work  at- 
tracted much  attention,  and  has  been  generally  regarded  as 
the  primary  basis  of  medico-legal  science. 

In  1637,  the  Royal  College  of  Physicians  of  London  pre- 
sented to  the  City  Council  a  "Report  on  all  such  annoyances 
as  they  conceive  likely  to  increase  the  sickness  of  this  Pop- 
ulous City."  And  Ludvig  von  Hoernigk,  of  Mayence,  in 
1638,  wrote  a  work  "On  the  duties  of  the  Medical  Profes- 
sion as  a  whole." 

Swammerdam  discovered  the  fact  that  human  lung  tis- 
sue that  had  been  fully  inflated  by  respiration  would  not 
afterwards  sink  in  water,  in  1667,  and  Malachias  Thuiston 
immediately  applied  it  as  an  important  test  for  deciding 
whether  a  child  had  been  born  dead  or  had  lived  long  enough 
to  breathe.  The  conditions  limiting  the  application  of  the 
test  were  pointed  out  by  Hartmann,  and  it  was  first  made 
available  during  the  trial  of  a  case  in  court  by  Joh.  Schreyer 
in  1681.  It  is  the  well  known  hydrostatic  test  of  modern 
works  on  medical  jurisprudence. 

The  active  progress  in  a  knowledge  of  all  the  depart- 
ments of  physics  and  the  natural  sciences  during  the  sev- 
enteenth century  was  intimately  connected  with  the  ad- 
vancements in  the  elementary  branches  of  medicine,  as 
illustrated  by  the  application  of  the  microscope,  in  com- 
pleting a  knowledge  of  the  circulation  of  the  blood  through 
the  capillaries  and  of  the  corpuscular  elements  of  the  blood 


83 

itself,  and  by  the  application  of  physical  laws  in  the  inven- 
tion of  instruments  and  appliances  of  value  in  the  practical 
branches  of  the  healing  art.  The  trochar  for  paracentesis 
abdominis  and  an  ingenious  self-injecting  apparatus  were 
invented  by  Sanctorius,  of  Padua.  The  tourniquet  was  in- 
vented by  the  French  surgeon  Morel  during  the  siege  of 
Besancon,  in  1674.  The  obstetric  forceps,  one  of  the  most 
important  instruments  in  use,  was  invented  by  Peter  Cham- 
berlen,  of  London,  early  in  the  century,  but  were  kept  as 
a  family  secret  many  years  for  private  gain.  The  use  of 
the  instrument  was  restricted  to  his  sons  and  a  few  other 
persons,  also  pledged  to  continue  the  secret. 

Notwithstanding  the  selfish  and  unjustifiable  policy  pur- 
sued by  the  Chamberlen  family,  the  instrument  became 
quite  well  known  in  England  before  the  end  of  the  century. 

Surgery:  The  internicene  and  so-called  "religious" 
wars  that  prevailed  in  Europe  during  the  greater  part  of 
the  seventeenth  century,  afforded  a  wide  field  for  practical 
surgery,  and  the  steady  progress  in  anatomy  and  physiol- 
ogy greatly  favored  coincident  progress  in  surgery  in  which 
the  English  and  French  took  the  lead.  Perhaps  the  best 
representative  of  English  surgery  during  that  period  was 
Richard  Wiseman,  ordinary  surgeon  to  'James  I.  and  after- 
wards in  the  service  of  Charles  I.  and  II.,  and  James  II. 
He  had  an  extensive  military  experience,  both  in  England 
and  on  the  Continent,  and  finally  settled  in  London,  in 
1652.  He  favored  primary  amputations,  especially  in  gun- 
shot injuries  of  the  joints;  preferred  to  operate  through 
healthy  tissues ;  treated  aneurisms  by  compression  ;  and  used 
the  ligature  for  the  control  of  hemorrhage,  except  on  the 
field  of  battle,  when  he  kept  the  actual  cautery  ready,  be- 
cause, he  said,  the  ligature  required  too  much  time  and  too 
many  assistants.  He  is  credited  with  having  been  the  first 
to  accurately  describe  the  white  swelling  under  the  name 
of  "tumor  albus."  He  established  the  indications  of  herni- 
otomy more  distinctly,  and  in  his  treatise  "On  the  ill  con- 
sequences of  Gonorrhea",  gave  the  first  recorded  case  of 
external  urethrotomy  for  stricture,  as  performed  by  Edward 


84 

Molins,  in  1652.  His  most  important  work  was  entitled 
"Several  Surgical  Treatises'',  published  in  London,  1676. 

Sir  Christopher  Wren,  who  was  a  learned  architect  as 
well  as  surgeon,  in  1657,  was  one  of  the  first  to  inject  med- 
icines into  the  veins,  which  was  soon  shown  to  have  the 
same  effect  as  when  taken  into  the  stomach.  In  France, 
Jean  Baptiste  Denis,  physician  of  Louis  XIV.,  aided  by  the 
surgeon  Emmerez,  performed  the  first  transfusion  of  blood 
in  man,  on  the  15th  of  June,  1667.  Edward,  King  of  Eng- 
land, repeated  the  operation  November  23d,  and  Riva,  in 
another  case,  in  December  of  the  same  year. 

In  Germany  perhaps  no  surgeon  during  this  century 
was  more  distinguished  for  his  learning,  or  exerted  more  in- 
fluence in  promoting  closer  relations  between  the  physiciais 
and  surgeons,  than  Fabricius  Hildanus,  of  Hilden.  He, 
like  many  of  the  surgeons  of  that  period,  practised  both 
ophthalmology  and  otolog}',  and  not  a  few  also  practised 
dentistry  and  obstetrics,  with  their  general  surgery. 

Medicine  :  The  effectual  overthrow  of  the  purely  the- 
oretical doctrines  of  the  ancients  founded  on  the  four  ele- 
ments, four  humors  and  their  concoctions,  and  the  vital 
spirits,  by  the  actual  development  of  chemistry,  anatomy, 
physiolog}^  and  pathological  anatomy,  in  close  connection 
with  the  rapid  progress  in  all  the  collateral  sciences  dur- 
ing the  sixteenth  and  early  part  of  the  seventeenth  centuries, 
led  to  many  attempts  to  construct  new  systems  or  theories 
of  diseases  and  their  treatment,  based  on  some  one  of  the 
recently  developed  sciences.  Thus  Van  Helmont,  at  the 
beginning  of  the  last-named  centur}-,  endeavored  to  cre- 
ate a  system  of  medicine  by  uniting  the  alchemistic  doc- 
trines of  Paracelsus  with  his  own  Archeus  or  dynamic 
force.  This  was  soon  superseded  by  the  latro-chemical 
system,  founded  by  Francois  de  la  Boe  or  Sylvius,  of  Ley- 
den,  and  Thomas  Willis,  of  Oxford.  They  attributed  dis- 
eases chiefly  to  changes  in  the  saliva,  pancreatic  juice,  and 
bile,  or  to  fermentation  in  the  blood,  and  endeavored  to 
explain  all  the  phenomena  of  both  health  and  disease  on 
chemical  principles. 

Somewhat  in  contrast  with  this,  was  the  latro-Physical 


85 

system,  the  ablest  supporter  of  which  was  Sanctorius,  a 
practitioner  of  Venice  and  professor  at  Padua.  He  prose- 
cuted investigations  concerning  the  insensible  transpira- 
tions from  the  skin,  the  excretion  by  the  kidney,  the  evacua- 
tions from  the  bowels,  and  the  variations  of  temperature  of 
the  body  and  of  the  pulse  by  the  aid  of  instruments  of  his 
own  invention,  with  a  perseverance  and  success  but  little 
less  creditable  than  those  prosecuted  by  Harvey  regarding 
the  circulation  of  the  blood.  Both  the  latro-Chemists  and 
the  latro-Physicists  retained  in  their  system  much  of  the 
humoralism  of  preceding  ages.  But  the  latro-Mathematical 
system,  founded  by  Giovanni  Alfonzi  Borelli,  of  Naples, 
was  one  of  solidism.  Borelli  and  co-workers  sought  to 
explain  muscular  action,  circulation,  secretion,  and  both 
physiological  and  pathological  processes  generally  on  purely 
mathematical  and  mechanical  principles.  They  endeavored 
to  explain  movements  produced  by  muscular  action  on  the 
principle  of  the  lever,  and  computed  mathematically  the 
amount  of  force  employed.  Thus  Borelli  estimated  the 
force  of  the  heart's  action  to  be  equal  to  1,500  kilograms 
per  minute,  while  others  figured  it  at  only  a  few  ounces. 

While  these  various  attempts  to  construct  theoretical 
systems  of  medicine  founded  on  the  coincident  advance- 
ments in  general  science  were  in  progress,  the  greater  num- 
ber of  active  practitioners,  led  by  Sydenham,  were  making 
greater  and  better  progress  by  a  return  to  the  Hippocratic 
method  of  patiently  observing  facts  and  deducing  practical 
conclusions  from  them. 

Thomas  Sydenham  was  born  at  Winford  Eagle,  in  Dor- 
setshire, in  1624,  and  died  in  London,  1689.  He  entered 
Magdalen  College,  University  of  Oxford,  in  1642,  but  was 
soon  interrupted  by  enlistment  in  the  Parliamentary  Army, 
in  which  he  held  the  office  of  captain ;  thus  placing  him  in 
political  antagonism  to  Harvey  who  was  on  the  side  of  the 
King.  He  re-entered  Oxford  in  1645,  and  took  his  Bac- 
calaureate degree  in  1648.  Subsequently  he  pursued  med- 
ical studies  at  Montpellier  for  a  considerable  time,  and 
finally  took  the  doctor's  degree  at  Cambridge,  was  admit- 
ted to  membership  in  the  Royal  College  of  Physicians  of 


86 

London,  and  settled  in  Westminster,  London,  in  1663.  His 
most  important  medical  work  was  entitled  "Observationes 
Medica",  published  in  1666.  He  early  adopted  Hippo- 
crates as  his  model,  and  discarding  all  attempts  to  con- 
struct theories  or  systems  of  medicine,  and  adopting  the 
Hippocratic  doctrine  that  disease  is  a  more  or  less  active 
effort  of  the  natural  functions  to  free  the  system  from  dis- 
turbing influences,  he  insisted  that  these  efforts  of  nature 
were  the  chief  agents  for  effecting  cures.  Consequently  he 
insisted  that  the  chief  business  of  the  physician  is  to  ob- 
serve carefully  the  conditions  and  circumstances  under 
which  diseases  arise,  and  with  equal  care  to  note  their  symp- 
toms, progress  and  terminations,  that  he  may  adopt  rational 
methods  for  obviating  the  first,  and  such  dietetic  and  thera- 
peutic measures  as  would  assist  the  natural  tendencies 
towards  a  cure. 

He  regarded  "inflammation  of  the  blood"  as  the  chief 
pathological  condition  in  acute  febrile  affections,  and  of- 
ten resorted  to  venesection,  cathartics,  diaphoretics,  cool 
drinks,  and,  in  the  latter  stages,  more  nourishment  and 
tonics,  especially  the  cinchona  bark,  which  he  aided  much 
in  gaining  a  favorable  introduction  to  the  profession  gen- 
erally. By  his  strenuous  defence  of  the  "healing  powers 
of  nature",  and  his  intelligent  adherence  to  the  study  of 
facts  and  the  phenomena  of  disease,  through  the  more  than 
forty  years  of  his  professional  life,  he  wielded  a  greater  in- 
fluence, and  did  more  to  advance  the  real  interests  of  prac- 
tical medicine,  than  any  other  practitioner  of  the  same  cen- 
tury. 

For  some  needed  comments  on  the  social  status  of  the 
profession,  the  conditions  of  the  medical  schools,  and  the 
prevalence  of  epidemics  during  this  century,  I  must  refer 
to  the  first  part  of  the  next  chapter. 


87 


CHAPTER  VII. 

THE  SOCIAL  STATUS  OF  THE  PROFESSION  ;  THE  PROGRESS  OF 
THE  MEDICAL  COLLEGES,  AND  THE  CHARACTER  OF  EPIDEM- 
ICS DURING  THE  SEVENTEENTH  CENTURY;  CONTINUED 
PROGRESS  OF  CHEMISTRY  AND  PHYSICS,  AND  THEIR  CON- 
NECTION WITH  THE  PROGRESS  OF  MEDICINE  DURING  THE 
EIGHTEENTH  CENTURY;  ALSO  ADVANCEMENTS  IN  PHYS- 
IOLOGY AND  IN  GENERAL  AND  PATHOLOGICAL  ANATOMY,  TO 
THE  END  OF  THE  EIGHTEENTH  CENTURY. 

The  social  condition  of  the  medical  profession  during 
the  seventeenth  century  was  characterized  by  marked  im- 
provement in  its  education,  its  stability  and  greater  unity 
of  purpose,  and  in  its  influence  in  directing  the  sanitary 
interests  of  the  people.  In  proportion  as  chemistr\',  anat- 
omy, physiology,  and  pathological  anatomy  developed  from 
observation,  experiment,  and  induction,  in  direct  connection 
with  the  similar  advancement  of  physics  and  all  branches 
of  the  natural  sciences,  in  the  same  proportion  did  the  prac- 
titioners of  both  medicine  and  surgery  cease  to  be  itinerant 
or  traveling  specialists.  From  the  re-establishment  of  med- 
ical schools  and  other  institutions  of  learning  in  Europe  on 
the  decline  of  the  Arabian  era,  to  the  commencement  of 
the  sixteenth  century,  a  large  proportion  of  the  medical  prac- 
titioners traveled  from  place  to  place,  and  often  from  one 
country  to  another,  claiming  either  superior  skill  in  the  per- 
formance of  important  operations,  or  the  possession  of  rem- 
edies of  unusual  efficacy  in  the  treatment  of  diseases.  Even 
the  professors  in  the  colleges  seldom  remained  in  the  same 
institution  many  years.  Thus  we  find  Vesalius,  the  anat- 
omist, teaching  successively  in  Padua,  Pisa,  Louvain  and 
Basil;  and  the  attendance  of  students  was  still  more  vari- 
able. 

It  is  claimed  by  Baas  and  other  historical  writers  that 
a  large  proportion  of  the  students  were  not  only  of  a  roving 
and  reckless  character,  changing  from  one  school  to  an- 
other without  let  or  hindrance,  but  often  committing  depre- 


dations  upon  the  rights  and  property  of  others.  It  was 
during  these  medieval  centuries,  that  students  organized 
themselves  into  bands  or  social  clubs,  with  badges,  mot- 
toes, and  sometimes  peculiarities  of  dress.  It  was  during 
this  same  period  of  time  that  senior  classes  assumed  the 
most  cruel  and  arbitrary  control  over  their  juniors  or  fresh- 
men, and  exacted  from  them  the  most  menial  service.  Un- 
fortunately these  barbarous  and  wholly  unjustifiable  stu- 
dent practices  are  not  yet  entirely  absent  from  the  colleges 
and  universities  of  our  own  time,  as  the  records  of  "hazing" 
and  initiatory  exercises  of  secret  societies  annually  show. 

During  the  sixteenth  century  the  Italian  Schools  began 
to  lose  their  prestige  as  those  of  Germany,  France  and  Eng- 
land advanced.  This  change  became  still  more  prominent 
during  the  seventeenth  century,  when  those  of  Paris,  Mont- 
pellier,  Berlin,  Leyden,  Heidelberg  and  Edinburgh  had  be- 
come the  chief  centers  for  medical  education  in  Europe. 

The  final  introduction  of  their  study  of  descriptive  anat- 
omy by  dissections  of  the  human  body  in  all  the  impor- 
tant medical  schools  during  this  century,  coupled  with  the 
fact  that  the  chief  teachers  of  anatomy  were  at  the  same 
time  most  prominent  as  surgeons,  aided  very  much  to  bring 
the  physicians  and  surgeons  together,  both  in  education  and 
in  practice.  Coincidently  with  this  came  the  protracted  and 
relentless  religious,  or  more  properly,  ecclesiastical,  wars 
that  devastated  Europe  for  thirty  years,  and  resulted  in  ef- 
fectually destroying  the  dominating  influence  of  priests  and 
ecclesiastics  over  medicine  and  medical  institutions,  and 
thereby  removed  one  of  the  obstacles  to  the  union  of  phy- 
sicians and  surgeons  as  one  profession.  While  the  College 
de  Come  was  doing  much  to  elevate  the  character  of  sur- 
gery in  France  and  to  separate  it  from  the  "barber  shop", 
an  equally  active  influence  was  being  exerted  in  England 
bv  the  incorporation  of  the  barber-surgeons  in  London  no- 
ticed in  a  previous  chapter.  In  15 12  a  new  charter  was 
granted  which  forbade  any  person  from  practising  surgery 
in  London  except  the  members  of  that  corporation.  In  1540 
another  act  was  passed  forbidding  the  barbers  who  prac- 
tised shaving  and  hair  dressing  from  doing  any  surgical 


89 

work  except  the  extraction  of  teeth.  On  the  other  hand, 
the  surgeons  were  forbidden  to  practise  shaving.  The  final 
legal  separation  of  the  surgeons  and  barbers  did  not  take 
place  until  1745,  when  an  act  was  passed  making  the  Col- 
lege of  Surgeons  and  the  Corporation  of  Barbers  entirely 
separate  bodies  and  limiting  the  practise  of  surgery  wholly 
to  the  membership  of  Colleges  of  Surgeons,  Physicians  and 
Apothecaries. 

The  Act  of  Incorporation  of  the  College  of  Physicians, 
London,  was  granted  in  15 18  during  the  reign  of  Henry 
VIIL,  chiefly  through  the  influence  of  Thomas  Linacre  and 
John  Chambers,  both  physicians  to  the  king.  It  restricted 
the  privilege  of  practising  medicine  in  the  city  of  London, 
or  within  seven  miles  of  it,  to  the  members  of  said  College. 
Until  this  time  medical  practitioners  were  required  to  pro- 
duce a  license  from  either  the  bishop  of  London  or  the  dean 
of  St.  Paul's. 

.  It  was  also  during  the  seventeenth  century  that  several 
scientific  societies  were  organized,  having  both  a  direct 
and  indirect  influence  on  the  medical  profession.  In  Lon- 
don the  "Invisible  Society",  at  first  a  secret  organization, 
was  founded  by  Milton  and  Hartleib,  in  1645,  but  publicly 
reorganized  into  the  Royal  Society  of  London  for  the  pro- 
motion of  the  Sciences  in  1662. 

In  France  the  "Academic  des  Sciences"  was  founded 
by  Colbert,  in  1665 ;  and  at  Schweinfurt,  Germany,  in  1652, 
was  founded  the  "Gesellschaft  naturforschender  Aerzte" 
Vv'hich  was  reorganized  in  1677,  and  is  still  doing  good  work. 

These  and  other  scientific  and  literary  societies  re- 
ceived many  papers,  bearing  more  or  less  on  the  progress 
of  medicine,  which  were  published  in  their  transactions, 
and  among  their  most  active  supporters  were  the  more 
eminent  members  of  the  medical  profession  in  each  coun- 
try. 

By  the  co-operation  of  all  the  foregoing  influences, 
during  the  seventeenth  century  all  the  departments  of 
medicine  advanced ;  the  medical  schools  and  their  faculties 
became  more  stable  and  better  organized ;  the  departments 
of  medicine,  surgery,  and  midwifery  acquired  greater  unity 


90 

as  one  profession ;  a  much  larger  proportion  of  the  active 
practitioners  selected  permanent  locations  or  fields  for 
practice,  while  the  services  of  a  large  number  were  con- 
stantly required  in  the  armies,  and  in  municipal  and  gov- 
ernment offices.  Still  there  remained  both  within  and 
without  the  profession,  an  abundance  of  ignorance,  bigotry, 
prejudice  and  exhibitions  of  vice  and  folly  in  all  the  coun- 
tries. 

Epidemics  :  All  the  epidemic  diseases  mentioned  in  pre- 
' ceding  chapters  continued  to  recur  during  this  century 
with  little  or  no  abatement  of  their  malignancy.  During 
the  "Thirty  Years'  War,"  in  the  first  half  of  the  century, 
epidemics  of  typhus  and  typhoid  fever,  dysentery,  and  ty- 
phoid pneumonia,  were  of  frequent  occurrence  and  very 
fatal. 

From  1657  to  1685  malarious  fevers  several  times  ap- 
peared in  a  highly  malignant  and  pandemic  form,  but  most 
severe  in  England  and  the  Netherlands.  Both  King  James 
I.  and  Oliver  Cromwell  are  reported  as  having  died  of 
the  ague.  In  their  time  the  soil  around  London,  in  Cam- 
bridgeshire and  Lincolnshire,  was  neither  drained  nor  cul- 
tivated. The  plague  also  prevailed  in  London  in  1603  to 
1608,  in  Ireland  in  1650,  and  again  in  London  in  1665, 
when  it  is  reported  to  have  destroyed  69,000  lives.  It 
repeatedly  appeared  in  different  parts  of  France,  Germany 
and  Italy.  In  Alilan,  where  it  is  said  to  have  destroyed 
180,000  lives,  its  prevalence  was  attributed  to  a  "Plague 
Salve"  supposed  to  have  been  rubbed  on  the  walls  of 
houses  by  a  barber  named  Mord  and  the  health  officer 
Piazza,  who  were  tried,  condemned,  cruelly  tortured,  and 
then  burned  to  death. 

Limited  epidemics  of  small-pox,  scarlet  fever,  diph- 
theria and  influenza  also  prevailed  at  different  times  both 
in  Europe  and  America.  Cases  of  undoubted  malignant 
diphtheria  occurred  in  Roxbury,  Mass.,  as  early  as  1659, 
when  four  children  of  one  family  died  from  what  was 
styled  "Bladders  in  the  windpipe."  But  the  first  full  ac- 
count of  a  severe  epidemic  of  the  disease  in  America  was 


91 

published  by   Dr.   Wm.   Douglass,   of   Boston,   Mass.,  in 
1736,  under  the  name  of  "Angina  Ulcusculoso." 

Clinical  Instruction  :  The  chief  attempts  to  illus- 
trate the  progress  of  disease  and  the  effects  of  treatment 
at  the  bed-side,  or  true  clinical  instruction,  were  made  by 
Dr.  William,  of  Utrecht,  in  1636,  Dr.  Albert  Kyper,  at 
Leyden,  in  1648,  and  still  more  successfully  by  Sylvius,  of 
Ley  den,  in  1658.  But  that  important  method  of  instruc- 
tion was  not  permanently  established  until  the  time 
of  Herman  Boerhaave,  of  Leyden,  at  the  beginning  of  the 
eighteenth  century. 

Herman  Boerhaave  was  born  in  1668,  at  Voorhout  near 
Leyden,  the  son  of  a  clergyman,  and  was  educated  for  the 
same  calling  as  his  father.  After  studying  thoroughly 
philosophy,  history,  metaphysics,  philology,  mathematics 
and  theology,  he  changed  his  purposes  and  with  equal  zeal 
studied  chemistry,  botany,  and  all  other  branches  of  med- 
icine as  the  pupil  of  Drelincourt  and  Nuck.  He  gradu- 
ated in  medicine  in  1693,  and  commenced  practice  in  Ley- 
den. In  1709  he  was  elected  to  the  chair  of  Botany,  and 
five  years  later,  on  the  death  of  Bidloe,  he  was  given  the 
chair  of  Practice  of  Medicine,  and  in  1718  he  acquired  also 
the  professorship  of  Chemistry,  in  which  he  gained  a  very 
high  reputation.  From  the  commencement  of  his  teaching 
practical  medicine,  in  1714,  he  freely  connected  therewith 
direct  clinical  instruction,  lecturing  extempore  with  such 
success  that  he  soon  attracted  the  attention  of  both  pa- 
tients and  students  in  numbers  greater  than  the  hospital 
and  college  rooms  could  accommodate.  He  persistently 
avoided  attempts  to  construct  any  theoretical  system  of 
medicine ;  placed  great  reliance  on  the  curative  powers  of 
nature ;  and  insisted  that  observation  and  experience  at 
the  bed-side  of  the  sick  were  the  safest  guides  in  the 
treatment  of  diseases.  He  was  probably  the  first  to  give 
separate  lectures  on  ophthalmology,  and  to  use  a  magnify- 
ing glass  in  examining  the  eye.  He  also  measured  the 
temperature  of  his  patients  by  applying  the  thermometer  in 
the  axilla. 

Dtiring  the   last   quarter  of   the   seventeenth   century 


92 

Nicholas  Lemery,  of  Paris,  Becher,  of  Mayence,  George 
Ernst  Stahl,  of  Halle,  and  Herman  Boerhaave,  of  Leyden, 
began  active  investigations  in  chemistry.  Becher  con- 
tended that  all  metals  and  combustible  bodies  were  com- 
posed of  three  varieties  of  earth,  i.  e.,  the  fusible,  combus- 
tible and  mercurial.  Stahl  accepted  the  doctrine  of 
Becher,  but  called  his  combustible  earth  phlogiston,  the 
substance  supposed  to  be  expelled  during  the  progress  of 
combustion  or  oxidation  and  evolvement  of  heat.  The 
residue  left  after  the  expulsion  of  the  supposed  phlogiston 
was  regarded  as  the  true  elementary  body.  Boerhaave, 
without  disputing  the  chemical  doctrines  of  Becher  and 
Stahl,  determined  to  subject  the  transmutation  pretentions 
of  the  Alchemists  to  a  crucial  test.  For  that  purpose  he 
kept  one  specimen  of  mercury  moderately  hot  for  fifteen 
years,  another  very  hot  six  months,  and  distilled  a  third 
specimen  five  hundred  times;  yet  all  the  specimens  were 
only  mercury  still. 

He  was  perhaps  the  first  to  declare  the  aflfinity  of 
heterogeneous  bodies  with  the  suggestion  of  some  definite 
law  regulating  their  combination ;  and  the  text-book  pub- 
lished by  him  aided  much  in  promoting  correct  methods  of 
studying  chemistry. 

As  a  man  of  great  erudition,  close  observation  and  log- 
ical reasoning,  he  had  few  equals  among  contemporaries ; 
and  as  a  general  practitioner  and  teacher  of  medicine  he 
gained  a  wider  reputation  and  more  influence  than  any 
other  physician  of  the  eighteenth  century.  His  advice  was 
sought  by  all  classes  of  people,  from  those  highest  in  au- 
thority to  the  common  laborer,  and  he  insisted  on  giving 
each  his  turn,  regardless  of  rank  or  wealth.  He  died  in 
1738  at  the  age  of  seventy  years,  leaving  a  large  fortune. 

The  true  nature  of  combustion  and  oxidation  processes 
were  not  understood  until  the  discovery  of  oxygen  gas 
as  an  elementary  body  by  K.  W.  Scheele  and  Joseph  Priest- 
ley, in  1774,  and  the  demonstration  that  atmospheric  air 
was  composed  of  a  definite  mixture  of  oxygen  and  nitro- 
gen by  Lavoisier ;  and  that  in  combustion  the  oxygen  was 
added  to  the  combustible  body,  increasing  its  weight,  in- 


93 

stead  of  the  separation  of  phlogiston  as  previously  taught 
by  Stahl. 

In  1 78 1  water  was  shown  to  be  a  compound  body  con- 
sisting of  hydrogen  and  oxygen,  as  demonstrated  by  Henry 
Cavendish  and  James  Watt.  During  this  period  arsenic 
and  cobalt  were  proved  to  be  simple  bodies  by  Brandt; 
chlorine  and  fluorine,  by  Scheele ;  platinum  and  molyb- 
denum, by  Wood;  chromium,  by  Vauquelin ;  nickel,  by 
Cronstedt ;  uranium  and  zirconium,  by  Klaproth ;  and  the 
first  medico-chemical  work  was  done  in  analysing  organic 
substances,  such  as  milk,  chyle,  bile,  and  other  secretions, 
by  Antoine  Francois  de  Fourcroy. 

While  these  rapid  advances  were  being  made  in  chem- 
istry, all  having  more  or  less  bearing  on  medicine,  equally 
rapid  progress  was  being  made  in  the  departments  of  phys- 
ics and  the  other  natural  sciences;  including  the  discov- 
ery of  electricity  and  magnetism,  by  Galvani,  Volta,  Count 
Rumford  and  others,  and  the  identity  of  electricity  with 
lightning,  by  Benjamin  Franklin. 

Near  the  close  of  the  eighteenth  century  both  chem- 
istry and  physics  and  their  relations  to  medicine,  were  still 
further  advanced  by  the  investigations  of  Wentzel  and 
Richter,  who  proposed  the  theory  of  chemical  equivalents ; 
Dalton,  author  of  the  Atomic  theory;  Guy  Lussac ;  Sir 
Humphrey  Davy ;  Thenard ;  Berzelius  ;  Faraday  and  others. 

Physiology:  The  investigations  of  William  Harvey 
explaining  the  circulation  of  the  blood  and  the  animal  gen- 
eration from  ova,  and  the  work  of  his  contemporaries  and 
followers  in  establishing  a  more  complete  knowledge  of 
lacteals,  lymphatics  and  capillary  vessels  and  their  con- 
nection with  the  general  circulation,  during  the  last  part 
of  the  seventeenth  century,  prepared  the  way  for  the  equally 
important  work  of  Albert  von  Haller,  of  Berne,  Switzer- 
land, in  the  field  of  physiological  science. 

Haller  v/as  born  in  Berne,  in  1708,  and  at  the  age 
of  fifteen  years  he  entered  the  University  of  Tubingen. 
Two  years  later,  1725,  he  went  to  Leyden  to  study  medi- 
cine under  Boerhaave  and  Albinus,  and  received  the  degree 
of  M.  D.  at  the  age  of  nineteen  years.     He  then  visited 


94 

London,  Paris  and  Basil,  actively  prosecuting  investiga- 
tions in  anatomy,  physiology,  botany  and  mathematics, 
and  then  returned  to  his  native  city  to  practise  his  profes- 
sion. In  1/34,  at  the  age  of  twenty-six  years,  he  was  ap- 
pointed director  of  the  Hospital  and  professor  of  Anatomy, 
and  soon  established  an  anatomical  theater  in  which  to 
prosecute  his  investigations.  In  1736  he  was  called  to 
Gottingen  as  professor  of  anatomy,  surgery,  chemistry  and 
botany,  and  there  became  the  founder  of  the  Botanical 
Garden,  Anatomical  Theater  and  a  Hall  of  Anatomical 
Drawing.  He  was  also  one  of  the  chief  founders  of  Koni- 
^liche  Gesellschaft  der  Wissenschaften,  of  which  he  was 
the  first  and  only  president  until  his  death.  In  1739  ^^  ^^^^ 
appointed  English  Physician-in-ordinary;  and  in  1749  made 
English  State  Councillor,  while  he  had  been  received  into 
the  Council  of  his  native  city,  in  which  he  served  until 
chosen  Landermann  of  the  Canton.  All  these  more  pub- 
lic duties  did  not  deter  him  from  the  active  and  persistent 
prosecution  of  physiological  and  scientific  investigations. 
His  work  on  physiology  was  published  in  1747,  and  an  ac- 
count of  his  researches  on  Irritability  in  1752,  and  sub- 
sequently his  most  noted  work  the  Bibliothecae.  Haller  is 
said  to  have  executed  more  than  five  hundred  experiments 
in  establishing  the  existence  of  irritability  as  a  property  of 
living  muscular  structure,  imparting  to  it  the  capacity  to 
contract  independent  of  nerves,  and  entirely  distinct  from 
sensibility,  that  being  restricted  to  nerve  tissue  alone.  In 
prosecuting  these  numerous  experiments  he  added  many 
new  items  to  our  knowledge  of  the  anatomy  of  the  brain, 
heart,  kidneys  and  sexual  organs  and  their  appendages. 
It  is  true  that  Glisson,  the  successor  of  Harvey  in  the  pro- 
fessorship of  Anatomy  and  Surgery  in  the  College  of  Phy- 
sicians, about  the  middle  of  the  seventeenth  century, 
taught  a  doctrine  of  irritability  deduced  from  the  fact  that 
all  living  structures  were  undergoing  constant  metabolic 
changes  or  movements  in  response  to  the  presence  of  ex- 
citors  or  stimuli.  But  the  word  susceptibility,  meaning  the 
capability  of  being  acted  upon  or  excited  to  action,  would 
better  express  the  idea  of  Glisson.       The  irritability  de- 


95 

scribed  by  Haller  as  distinct  from  nerve  sensibility  and 
limited  to  muscular  structures  only,  evidently  included  the 
capacity  to  contract,  and  might  have  been  better  indicated 
by  the  word  contractility,  especially  as  he  regarded^  it  as 
the  cause  of  muscular  movements. 

The  doctrine  of  irritability,  as  taugh  by  Haller  and  his 
numerous  experimental  investigations,  led  to  a  very  gen- 
eral study  of  the  physiological  question  suggested  thereby, 
by  all  the  leading  minds  in  the  profession.  Many  construed 
the  doctrine  as  an  elementary  property  belonging  to  all 
living  organized  structures  in  accordance  with  the  expres- 
sion of  Glisson ;  others  gave  it  the  more  limited  range  of 
belonging  to  fibrous  or  muscular  structures  only,  as  viewed 
by  Haller ;  and  still  others  continued  to  regard  it  as  a  man- 
ifestation of  nerve  sensibility  under  the  leadership  of  Wil- 
liam Cullen,  of  Edinburgh.  All,  however,  were  speedily 
led  to  abandon  the  last  remnants  of  the  humoral  doctrines 
of  the  ancients,  together  with  the  vis  anima  of  Stahl  and 
the  vital  ether  of  Hoffmann,  and  to  adopt  an  exclusive 
solidism  both  in  physiology  and  pathology. 

In  applying  the  doctrine  of  irritability  to  the  study  of 
embryology,  Haller  and  his  more  direct  followers  agreed 
with  Harvey  that  the  germinal  cell  of  the  ovum  contained 
in  itself  the  minute  points  of  all  parts  of  the  future  mature 
animal;  and  that  the  process  of  generation  was  one  of 
simple  evolution  or  growth  from  previously  existing  em- 
bryonic matter  in  the  germinal  cell  of  the  ovum. 

On  the  other  hand,  Caspar  F.  Wolff,  of  St.  Petersburg, 
one  of  the  earliest  of  the  noted  Russian  investigators,  re- 
vived the  ancient  theory  of  epigenesis,  i.  e.,  that  the  pro- 
cess of  generation  was  an  actual  new  creation.  He  was 
also  the  first  to  claim  that  tissue  cells  contain  no  true  cav- 
ities within. 

A  little  later  the  doctrine  of  a  "nisus  formativus",  or  in- 
herent impulse  of  the  impregnated  germ  to  preserve  and 
perpetuate  from  generation  to  generation  its  own  form 
and  species,  was  promulgated  by  the  eminent  anthropo- 
logical investigator,  J.  F.  Blumenbach,  of  Gotha,  and  pro- 
fessor in  Gottingen.     He  was  also  the  founder  of  modern 


96 

anthropology  and  made  a  remarkable  collection  of  skulls, 
both  human  and  comparative,  called  his  "Golgotha." 

For  nearly  fifty  years,  commencing  1721,  Bernhard  F. 
Albinus  taught  anatomy  in  the  school  at  Leyden.  Aided 
by  the  artists  W'andelaar  and  Ladmiral  he  published  fairly 
accurate  descriptions  of  nearly  all  parts  of  the  human  body, 
illustrated  by  admirably  colored  plates.  He  was  perhaps 
the  first  to  demonstrate  by  injections  the  actual  vascular 
connection  between  the  mother  and  the  foetus  through  the 
placenta. 

During  the  last  part  of  the  eighteenth  century  those 
who  most  successfully  advanced  the  departments  of  anat- 
omy, physiology  and  pathology  beside  those  already  men- 
tioned, were  Sommerring,  of  jMayence,  and  Cassel ;  William 
and  John  Hunter  and  John  Bell,  of  London  ;  G.  B.  Morgagni, 
of  Forti,  Italy ;  and  ^i.  F.  X.  Bichat,  of  Paris. 

jMorgagni  became  a  professor  in  Padua  in  1715,  and 
for  many  years  industriously  pursued  the  study  of  patho- 
logical anatomy,  including  the  changes  and  products  de- 
veloped in  the  progress"  of  a  large  number  of  the  most  com- 
mon diseases.  He  published  his  great  work  on  Patholog- 
ical Anatomy,  consisting  of  five  books  or  volumes,  in 
Venice  in  1761,  which  justly  entitles  him  to  the  honor  of 
being  the  founder  of  that  branch  of  medical  science. 

William  Hunter  was  born  in  Long  Calderwood,  Scot- 
land, and  was  first  educated  for  the  ministry,  but  subse- 
quently turned  his  attention  to  medicine  and  became  a 
pupil  of  Cullen,  in  Edinburgh.  He  went  to  London  in 
1741,  and  commenced  lecturing  on  Anatomy  and  Sur- 
gery in  1746.  He  rapidly  acquired  a  high  reputation  and 
extensive  practice  in  both  surgery  and  midwifery.  He 
devoted  much  attention  to  pathological  anatomy,  and  is 
said  to  have  spent  half  a  million  dollars  on  his  house, 
library,  and  collection  of  normal  and  pathological  anat- 
omy. The  latter  have  been  well  preserved  and  now  con- 
stitute the  Hunterian  Museum  of  the  University  of  Glas- 
gow. 

His  most    im'portant    works    were    entitled    "Aledical 


97 

Commentaries",  published  in  1764,  and  the  "Anatomia 
Humani  Uteri  Gravidi''  in  1774      He  died  in  1783. 

John  Hunter,  a  younger  brother  of  William,  was  born 
in  1728  and  died  in  1793.  He  commenced  work  as  a 
ship-carpenter,  but  in  a  few  years  he  changed  that  for 
the  study  of  medicine  as  the  pupil  of  his  brother  William 
and  of  Cheselden  and  Pott,  of  London ;  and  commenced  the 
practise  of  surgery  in  the  last  named  city  in  1763.  Five 
years  later  he  became  surgeon  to  St.  George's  Hospital, 
in  1776  surgeon  extraordinary  to  the  King,  and  in  1790 
he  was  surgeon  general  of  the  English  Armies.  Though 
his  rapid  and  high  official  advancement  were  thus  in  the 
line  of  surgery,  he  was  an  untiring  and  successful  investiga- 
tor in  the  departments  of  anatomy,  both  normal  and  path- 
ological, human  and  comparative,  and  in  several  of  the 
natural  sciences.  He  investigated  experimentally  patho- 
logical conditions  of  the  blood  in  inflammation ;  was  the 
first  to  describe  phlebitis ;  the  different  forms  of  chancre  in 
syphilis,  and  the  constitutional  conditions  following.  His 
collection  of  anatomical  and  pathological  specimens  were 
purchased  by  the  government  for  $75,000  and  given  to  the 
College  of  Surgeons,  and  still  constitute  a  large  part  of 
the  Hunterian  Museum  in  London.  His  most  valuable 
publications  were  "On  Venereal  Disease",  "On  the  Blood, 
Inflammation  and  Gunshot  Wounds",  and  "On  the  Natural 
History  of  Human  Teeth". 

The  closing  years  of  the  eighteenth  century  were  ren- 
dered notable  by  the  climax  reached  in  the  development 
of  anatomical  knowledge  during  the  brilliant  though  brief 
career  of  M.  F.  X.  Bichat,  the  creator  of  the  department 
of  General  Anatomy.  He  was  born  in  Thoirette,  France, 
in  1771,  the  son  of  a  physician,  and  commenced  his  edu- 
cation at  Nantes.  He  prosecuted  his  medical  studies  at 
Lyons  and  Montpellier,  and  subsequently  became  a  pupil 
and  an  assistant  of  the  eminent  surgeon  Desault  in  Paris, 
He  developed  an  extraordinary  degree  of  mental  activ- 
ity and  some  original  methods  of  investigation  especially  in 
normal  and  pathological  anatomy. 

After  the  death  of  Desault  in  1795  Bichat  lectured  on 


98 

surgery  and  after  1797  he  added  private  courses  on  anat- 
omy. He  founded  the  Societe  d'Emulation ;  was  appointed 
to  the  Hotel  Dieu  in  1801,  and  died  the  following  year  from 
pulmonary  tuberculosis,  aged  only  thirty-one  years.  Yet 
during  the  eleven  years  of  his  professional  career  he  wrote 
no  less  than  nine  important  volumes,  the  most  valued  of 
which  were,  a  Treatise  on  Membranes  in  1800;  one  on 
General  Anatomy  in  1801  ;  and  one  on  Pathological  Anat- 
omy, which  was  published  several  years  after  his  death. 
In  addition  to  the  ordinary  methods  of  dissection  in  the 
study  of  anatomy  he  not  only  studied  each  membrane, 
but  traced  each  organized  structure  wherever  it  was  to 
be  found  both  in  its  healthy  and  diseased  conditions.  In 
doing  this  he  is  said  to  have  examined  seven  hundred 
bodies  during  a  single  winter.  The  results  are  to  be  found 
in  his  two  remarkable  volumes  on  General  and  Patholog- 
ical Anatomy.  He  described  twenty-one  distinct  simple 
tissues  which  by  their  combinations  constitute  the  different 
organs  and  parts  of  the  bod>^  as  recognized  in  ordinary  de- 
scriptive anatomy.  He  not  only  showed  that  each  primary 
or  simple  structure  retained  the  same  properties  or  func- 
tions wherever  found,  but  was  also  subject  to  the  same 
morbid  processes  or  diseases. 

In  thus  prosecuting  his  study  of  anatomy  analytically, 
according  to  the  tissues,  both  healthy  and  diseased,  Bichat 
rendered  much  aid  in  diagnosis  and  prepared  the  way  for 
the  brilliant  developments  in  morbid  anatomy  and  differ- 
ential diagnosis  by  the  French  School  of  the  first  half  of 
the  nineteenth  century.  He  was  perhaps  the  first  to 
demonstrate  that  the  acute  morbid  condition  called  peri- 
pneumonia, was  capable  of  being  resolved  into  a  pleurisy, 
a  pneumonia,  or  a  bronchitis,  according  to  the  tissues  in- 
volved, and  each  presenting  reliable  diagnostic  symptoms. 
He  strenuously  insisted  that  the  actual  study  of  the  patho- 
logical conditions  in  internal  organs,  by  post-mortem 
examinations  and  comparing  them  with  the  symptoms  be- 
fore death,  was  essential  for  the  establishment  of  correct 
methods  of  diagnosis.  He  did  much  to  check  the  purely 
theoretic   tendencies   of   the  profession,   and   to   promote 


99 

the  careful  observation  of  facts  and  their  comparison  as 
affording  the  chief  basis  for  legitimate  deductions. 

Probably  there  is  the  name  of  no  other  member  of  the 
profession  on  the  pages  of  Medical  History,  who  accom- 
plished as  much  valuable  scientific  work  in  the  brief  period 
of  eleven  years,  as  was  done  by  Bichat  in  the  closing  years 
of  the  eighteenth  century.  In  1857  a  monument  was 
erected  to    his  memory  in  the  Ecole  de  Medicine  at  Paris. 

A  review  of  the  more  important  advancements  in  the 
strictly  practical  branches — surgery,  midwifery,  practical 
medicine,  and  public  hygiene  or  preventive  medicine,  dur- 
ing the  eighteenth  century,  is  considered  in  the  next  chap- 
ter. 


100 


CHAPTER  VIII. 

THE  HISTORY  OF  MEDICINE  DURING  THE  EIGHTEENTH  CEN- 
TURY CONTINUED.  THE  PROGRESS  OF  SURGERY,  MID- 
WIFERY, PR^\CTICE  OF  MEDICINE,  AND  HYGIENE  OR  PRE- 
VENTIVE   MEDICINE, 

The  numerous  and  important  advancements  made  in 
the  departments  of  physics,  chemistry,  physiology,  and 
anatomy,  both  normal  and  pathological,  during  the  eigh- 
teenth century,  as  shown  in  the  preceding  chapter,  were 
accompanied  by  corresponding  progress  in  all  the  more 
practical  branches  of  medicine. 

Surgery  :  As  nearly  all  those  who  were  active  and  suc- 
cessful investigators  and  teachers  of  anatomy  were  at  the 
same  time  active  practitioners  of  surgery,  the  latter  could 
not  fail  to  profit  more  or  less  by  each  advance  in  the  for- 
mer. Early  in  the  century,  William  Cheselden,  who  was 
born  in  Leicestershire,  England,  in  1688,  commenced  lec- 
turing on  anatomy  and  surgery  in  1710,  and  soon  acquired 
a  high  reputation  and  an  extensive  surgical  practice.  He 
w^s  perhaps  the  first  to  make  an  artificial  pupil  by  incision 
of  the  iris  with  a  needle  introduced  through  the  sclera.  He 
was  noted  for  unusual  dexterity  in  operating,  especially  for 
the  removal  of  calculi  from  the  urinary  bladder.  In  per- 
forming the  operation  of  lithotomy  he  preferred  the  lateral 
section,  which,  it  is  claimed,  he  performed  in  fifty-four 
seconds  of  time.  His  Avork  on  the  "Anatomy  of  the 
Human  Body"  was  published  in  1713;  a  "Treatise  on  the 
High  Operation  for  Stone"  in  1723,  and  a  more  noted 
work  on  "Osteology,  or  the  Anatomy  of  the  Bones"  in 
1733.  He  was  surgeon  to  St.  Thomas's  and  Chelsea  Hos- 
pitals, and  chief  surgeon  to  Queen  Caroline. 

Samuel  Sharp,  of  London,  a  pupil  of  Cheselden  and  a 
surgeon  of  Guy's  Hospital,  also  gained  a  high  reputation 
both  as  an  oculist  and  general  surgeon.  Alexander  Mon- 
ro Sen,  of  Edinburgh,  born  in  1697,  became  professor  of 
both  Anatomy  and  Surgery,  and  by  his  industry  and  skill 


lOI 

he  added  much  to  the  reputation  of  the  Edinburgh  Medical 
School. 

Charles  White,  a  surgeon  of  Manchester,  was  the 
pioneer  of  conservative  surgery.  He  first  resected  the 
humerus  leaving  the  periosteum,  and  thereby  gained  a 
complete  regeneration  of  the  bone,  in  1768.  Wainman 
and  Shripton  had  successfully  exsected  the  elbow  joint  in 
1758.  Charles  White  demonstrated  the  practicability  of 
resecting  the  hip  joint  on  the  cadaver,  and  he  was  the 
first  to  practise  the  reduction  of  dislocation  of  the  shoulder 
by  placing  the  heel  in  the  axilla. 

Percival  Pott,  of  London,  born  in  1713,  and  surgeon  to 
St.  Bartholomew's  Hospital  from  1769  to  1787,  did  much 
for  the  better  treatment  of  diseases  of  the  spine  and 
chronic  diseases  of  the  joints  generally.  He  wrote  a  val- 
uable essay  on  the  Diseases  and  Deformities  of  the  Spinal 
Column,  which  caused  the  angular  spinal  curvatures  to  be 
called  "Pott's  Disease."  His  complete  surgical  works 
were  published  in  London  in  1771. 

(The  eminent  character  and  valuable  works  of  the  Hun- 
ters, William  and  John,  were  mentioned  in  the  preceding 
chapter  in  connection  with  the  subjects  of  normal  and 
pathological  anatomy.) 

Benjamin  and  John  Bell,  of  Edinburgh,  were  both  emi- 
nent practitioners  and  teachers  of  surgery  during  the  last 
part  of  the  eighteenth  century.  The  first  gave  much  at- 
tention to  the  treatment  of  fractures  and  dislocations,  white 
swellings  of  the  joints,  and  ulcers.  He  wrote  a  volumi- 
nous System  of  Surgery,  published  in  Edinburgh,  in  six 
volumes,  1783-87. 

Thomas  Bayford  established  the  correct  diagnosis  be- 
tween the  contagions  of  gonorrhoea  and  syphilis ;  and 
Richard  Bayley,  of  New  York  City,  successfully  disarticu- 
lated the  shoulder  joint  in  1782. 

Many  of  the  English  surgeons  practised  also  exten- 
sively as  oculists,  dentists  and  obstetricians. 

In  France,  more  than  in  any  other  country  during  the 
eighteenth  century,  greater  advancements  were  made, 
both  in  surgical  practice  and  in  the  relative  rank  of  surgical 


102 

practitioners,  than  during  any  other  equal  period  of  time. 
The  "Academic  de  Chirurgie"  was  founded  in  1731,  chiefly- 
through  the  influence  of  Marechal  and  Francois  Gigot  de 
La  Peyronie.  The  latter  devoted  both  his  time  and  his 
fortune  in  sustaining  the  interests  of  his  favorite  depart- 
ment. He  was  not  only  an  active  director  of  the  Academic 
de  Chirurgie,  but  he  secured  the  establishment  of  several 
professorships  of  Surgery,  both  in  Paris  and  ]\Iontpellier. 
He  was  surgeon  to  the  King,  and  in  1743  he  completed  the 
separation  of  surgeons  from  the  barbers ;  and  at  his  death 
in  1747,  he,  by  will,  devoted  the  greater  part  of  his  remain- 
ing estate  to  the  further  advancement  of  the  same  pro- 
fessional objects  for  which  he  labored  faithfully  during  life. 
Contemporary  with  Peyronie,  and  more  famous  as  a 
practitioner  and  teacher  of  all  parts  of  surgery,  was  Jean 
Louis  Petit,  of  Paris,  born  in  1674  and  died  in  1750.  He 
was  one  of  the  early  Directors  of  the  Academic  de  Chir- 
urgie; improved  several  surgical  instruments;  practised 
herniotomy  without  opening  the  sac ;  and  acquired  a  very 
high  reputation  in  both  civil  and  military  surgery. 

Later  in  the  century  Pierre  Joseph  Desault  became  the 
leading  surgeon  in  Paris.  He  was  the  son  of  a  farmer,  born 
in  1744,  and  obliged  to  support  himself  by  teaching  while 
pursuing  his  medical  studies  in  Paris.  After  commencing 
practice  he  acquired  reputation  rapidly,  became  professor 
and  chief  surgeon  to  the  Hotel  Dieu,  in  which  he  estab- 
lished its  first  surgical  clinic.  He  gave  special  attention 
to  the  study  of  surgical  anatomy  and  improved  many  sur- 
gical operations  and  instruments.  In  dressing  wounds, 
he  not  only  insisted  on  thorough  cleanliness,  but  also  such 
closure  as  to  favor  permanent  union  by  first  intention  or 
direct  adhesion  without  suppuration. 

Many  of  the  most  enterprising  surgeons  in  France,  like 
those  of  England,  gave  no  little  attention  to  ophthalmol- 
ogy, otology  and  dentistr\'.  The  first  formal  work  on 
the  last  named  branch  was  written  by  Pierre  Fauchard,  of 
Paris,  entitled  "Le  Chirurgien  Dentiste,  ou  Traite  des 
Dens",  published  in  1728. 

The  first  catheterization  of  the  Eustachian  tubes  ap- 


103 

pears  to  have  been  accomplished  by    Archibald    Cleland, 
an  EngHsh  surgeon,  in  1741. 

Surgery  advanced  much  less  rapidly  in  Germany  and 
Austria  than  in  England  and  France.  During  the  first 
half  of  the  century  Lorenz  Heister,  of  Frankfort-on-the- 
Main,  was  the  most  noted  surgeon  of  Germany  and  author 
of  valuable  works  on  anatomy  and  surgery.  He  was  the 
first  in  that  country  to  teach  that  cataract  was  caused  by 
opacity  or  cloudiness  of  the  lens. 

In  the  last  half  of  the  century  August  Gottlieb  Richter, 
of  Zorbig,  gained  a  high  reputation  as  a  surgeon  and  as 
a  professor  in  Gottingen.  Though  a  general  surgeon  he 
devoted  much  attention  to  diseases  of  the  eye,  and  to 
improvements  in  operative  procedures. 

During  the  same  period  of  time  George  Jos.  Beer,  a 
professor  in  the  Vienna  University,  gained  a  still  higher 
reputation  in  the  department  of  ophthalmology,  on  which 
he  gave  separate  lectures,  thereby  adding  much  to  the 
reputation  of  the  Vienna  school.  He  divided  inflamma- 
tory affections  of  the  eye  into  idiopathic  and  those  excited 
by  local  irritants  or  by  sympathy,  and  studied  the  patho- 
logical changes  taking  place  during  their  progress.  He 
also  made  important  improvements  in  the  operations  for 
cataract  and  the  formation  of  artificial  pupils. 

J.  Andr.  Venel,  of  Orbe,  Switzerland,  was  a  pioneer 
orthopedist,  who  gained  considerable  reputation  for  the 
treatment  of  club  foot  and  crooked  joints. 

It  is  thus  seen  that  throughout  the  eighteenth  cen- 
tury, surgery  in  all  its  departments  made  steady  advance- 
ment, pari  passu,  with  the  progress  of  descriptive,  general 
and  pathological  anatomy ;  and  chiefly  by  the  same  indi- 
vidual members  of  the  profession.  Its  separation  from  the 
"barber  shop"  and  the  domination  of  ecclesiastics,  that 
had  fairly  commenced  in  the  seventeenth  century,  was 
fully  completed  during  the  eighteenth  by  the  establish- 
ment of  well  sustained  chairs  of  surgery  in  all  the  medical 
schools,  both  in  Europe  and  America,  and  the  admission 
of  surgeons  to  equal  professional  and  social  standing  with 
general  practitioners  of  the  healing  art. 


104 

Midwifery  :  As  during  all  the  earlier  centuries  sur- 
gery was  compelled  to  remain  in  the  hands  of  the  barbers, 
so  midwifery  was  equally  confined  to  the  management  of 
uneducated  midwives  or  menial  servants ;  and  if  help  was 
called  for  resort  was  had  to  the  surgeon  rather  than  to 
the  physician,  for  the  reason  that  the  assistance  required 
generally  involved  mechanical  or  operative  procedures  in 
aid  of  deliveries.  Consequently,  as  stated  in  previous 
chapters,  the  Cjesarean  section  was  early  resorted  to,  and 
instruments  were  invented  and  used  for  efifecting  craniot- 
omy and  the  extraction  of  the  child  in  pieces. 
But,  as  has  been  previous  stated,  the  invention  of 
the  obstetric  forceps,  by  which  deliveries  could  be 
effected  generally  without  injury  to  the  mother  or 
child,  did  not  occur  until  the  early  part  of  the 
seventeenth  century,  and  then  the  inventor,  Peter 
Chamberlen,  a  member  of  the  Guild  of  Barber  Sur- 
geons of  London,  and  his  descendants,  kept  a  knowledge 
of  the  invention  so  far  a  secret,  for  purpose  of  private  gain, 
that  it  became  known  to,  and  used  by,  only  a  limited  num- 
ber of  members  of  the  profession,  even  in  England,  until 
the  beginning  of  the  eighteenth  century.  In  fact,  so  little 
was  known  on  the  continent  concerning  the  Chamberlen 
invention  that  Jean  Palfyn  invented  an  instrument  for 
the  same  purpose,  which  he  exhibited  to  the  Paris  Acad- 
emic des  Sciences  in  1721.  Though  called  obstetric  for- 
ceps or  "Palfyn's  hand",  it  was  composed  of  three  blades 
without  fenestra  or  lock,  and  consequently  was  incapable 
of  efficient  use  until  improved  by  Duce  of  Paris  in  1735. 

Just  prior  to  this  latter  date,  however,  full  descriptions 
of  the  Chamberlen  forceps  were  published  by  both  William 
Giflford  and  Edmund  Chapman,  of  London,  the  latter  hav- 
ing used  them  in  his  practice  more  than  ten  years.  By 
these  publications,  aided  by  those  of  William  Smellie,  of 
London,  a  few  years  later,  the  instrument  soon  became 
known  to  the  profession  both  in  Europe  and  America.  Its 
form  and  methods  of  use  were  much  improved  by  the  last 
named  writer,  whose  valuable  "Treatise  on  the  Theory 
and  Practice  of  Midwifery"  was  published  in   1752.     He 


105 

also  directed  attention  to  the  several  conjugate  diameters 
of  the  pelvis,  and  gave  practical  directions  for  efiecting 
cephalic  version  and  versions  by  the  breech.  The  im- 
provements effected  by  Smellie  and  his  strong  recom- 
mendation of  the  use  of  instruments  in  many  cases  of 
natural  labor,  led  not  only  to  the  rapid  introduction  of  his 
forceps  into  general  use,  but  caused  it  to  be  used  in  many 
cases  needing  no  such  aid.  This  abuse,  however,  was 
effectually  checked  by  the  decided  opposition  of  William 
Hunter,  eminent  both  as  a  surgeon  and  obstetrician.  He 
was  followed  on  the  same  conservative  line  by  Thomas 
Denman,  whose  work  entitled  "Introduction  to  the  Prac- 
tice of  Midwifery"  was  published  in  London,  1787.  He 
described  more  fully  the  mechanism  of  natural  labors ;  the 
conditions  justifying  versions ;  and  those  requiring  the  use 
of  the  forceps.  In  cases  of  known  great  contraction  of 
the  pelvis,  he  recommended  the  induction  of  prema- 
ture labor  instead  of  the  Csesarean  section  at  the  full  pe- 
riod. In  1736,  Sir  Richard  Manningham  established  the 
first  private  lying-in  asylum  in  London. 

Andre  Levret,  of  Paris,  contemporary  with  Smellie 
and  William  Hunter,  of  London,  was  perhaps  the  most 
eminent  teacher  and  practitioner  of  midwifery  on  the  con- 
tient  during  the  middle  part  of  the  eighteenth  centur}'. 
His  teaching  was  characterized  by  good  judgment,  free 
from  extravagances  and  attracted  pupils  from  all  the  neigh- 
boring countries.  In  cases  of  placenta  previa,  he  advised 
detaching  it  from  the  edge,  rather  than  penetrating  directly 
through  it.  His  most  important  work  was  a  Treatise  on 
Accouchement,  published  in  1753. 

Later,  Jean  Louis  Baudelocque,  of  the  same  city,  be- 
came a  leader  in  the  department  of  obstetrics,  and  opposed 
the  recommendation  of  Denman  to  procure  premature 
labor  in  cases  of  great  contraction  of  the  pelvis.  He  also 
invented  an  external  pelvimeter. 

John  Georg  Roderer,  of  Strassburg,  became  the  first 
professor  of  midwifery  in  Germany,  at  Gottingen,  in  175 1. 
He  was  well  versed  in  anatomy  and  physiology,  and  based 
on  them  his  science  of  obstetrics;  and  also  aided  greatly 


io6 

in  diffusing  through  Germany  a  more  scientific  grade  of 
practical  obstetrics.  He  discouraged  the  prevalent  ten- 
dency to  use  instruments,  especially  such  as  involved  injury 
either  to  the  mother  or  child. 

But  the  application  of  scientific  principles,  derived  from 
a  correct  knowledge  of  anatomy  and  physiology,  in  the 
practice  of  obstetrics,  made  slower  progress  in  Germany, 
Austria,  Italy  and  Spain  than  in  England,  France,  or 
America.  The  English  colonies  in  North  America  de- 
rived their  medical  men  partially  from  immigration  from 
the  mother  country,  and  in  part  from  enterprising  young 
men  who,  born  in  the  colonies,  resorted  to  the  medical 
schools  of  Europe,  and  especially  to  the  University  of 
Edinburgh,  for  their  medical  education.  It  was  chiefly  by 
men  belonging  to  the  last  named  class  that  the  first  medical 
schools  were  established  in  Philadelphia  and  New  York, 
near  the  middle  of  the  eighteenth  century.  Consequently 
the  progress  of  midwifery  and  all  the  other  practical 
branches  in  the  English,  French  and  Dutch  colonies  of 
America  kept  even  pace  with  the  same  in  England  and 
France. 

On  the  organization  of  a  medical  school  in  connection 
with  King's  (now  Columbia)  College  in  New  York,  1768, 
full  professorships  of  Anatomy ;  Surgery ;  Physiology  and 
Pathology ;  Chemistry  and  Materia  Medica ;  Midwifery  and 
Theory  and  Practice  of  Physic  were  established,  and  Dr. 
John  V.  B.  Tennent  was  appointed  to  the  chair  of  Mid- 
wifery, which  he  filled  with  credit  several  years.  About  the 
same  time  Dr.  William  Shippen  gave  lectures  on  mid- 
wifery, in  addition  to  his  chair  of  Anatomy  and  Surgery 
it,  the  medical  school  established  in  Philadelphia,  in  1765. 
As  nearly  all  the  important  advancements  in  midwifery 
during  the  eighteenth  century  were  the  result  of  coinci- 
dent improvements  in  anatomy,  physiology  and  surgery,  it 
was  natural  that  in  passing  from  the  hands  of  the  mid- 
wife it  should  first  find  lodgment  in  the  hands  of  the  sur- 
geon before  reaching  full  recognition  as  an  independent 
branch  of  medicine.  Therefore  we  find  that  through  the. 
greater   part   of   the   eightenth    century,    the    teaching   of 


107 

midwifery  in  the  medical  schools  was  committed  to  the 
professor  of  Anatomy  or  Surgery,  and  in  many  places 
all  the  three  branches  were  taught  by  one  and  the  same 
professor.  But  its  independent  position  was  very  gener- 
ally admitted  before  the  end  of  the  century,  and  the  works 
of  Smellie,  William  Hunter  and  Andre  Levret  were  in  gen- 
eral use  both  as  text-books  and  for  reference. 

Practice  of  Medicine  :    Notwithstanding  the  many  at- 
tempts to  construct  special  systems  of  medical  pathology 
and  practice  during  the  seventeenth  century,  a  large  major- 
ity of  the  educated  practitioners  followed  the  teachings  of 
Sydenham  and  Boerhaave.     The  thoroughly  eclectic  doc- 
trines of  the  latter,  coupled  with  the  display  of  unusual 
practical  good  sense  in  their  application,  caused  them  to 
maintain  a  controlling  influence,  not  only  during  the  last 
half  of  the  seventeenth,  but  also   during  a  considerable 
part  of  the  first  half  of  the  eighteenth  century.     But  the 
coincident  discoveries  in  the  department  of  physiology  and 
pathological  anatomy;  more  especially  the  demonstration 
of  irritability  and  contractility  in  living  tissues  independent 
of  nerve   sensibility,   by   Haller,   led   rapidly  to  the   final 
abandonment  of  what  had  remained  of  the  humoral  doc- 
trines of  the  ancients  and  also  of  the  vis  anima  of  Stahl  and 
the  vital  ether  of  Hoffman.     In  their  stead,  the  irritability 
of  Glisson  and  Haller  was  accepted  as  an  inherent  prop- 
erty of  living  organized  matter,  giving  it  the  capacity  to 
respond  to  the  action  of  stimuli,  which  led  directly  to  the 
inference  that  all  vital  action,  whether  normal  or  abnormal, 
resulted  from  the  influence  of  stimuli.     If  the  stimuli  were 
natural,  as  wholesome  food,  drink,  and  air,  and  in  natural 
proportions,  the  vital  actions  resulting  were  healthy.     If 
they  were  applied  with  either  too  little  or  too  great  a  de- 
gree of  intensity,  or  of  an  unnatural  quality,  the  resulting 
actions  would  be  unnatural,  constituting  disease.     Conse- 
quently before  the  middle  of  the  eighteenth  century  all 
diseases  came  to  be  regarded  as  the  direct  or  indirect 
result  of  the  action  of  stimuli  or  irritants  on  the  organic 
irritability,   constituting  a  system  of  medicine   as  exclu- 
sively solidistic  as  any  of     those  of  the     ancients  were 


io8 

humoral.  The  soUdism  thus  generally  adopted  led  to  diver- 
gent views  in  its  practical  application.  As  has  been  pre- 
viously stated,  not  a  few  continued  to  claim  that  the  irri- 
tability of  Haller  was  only  nerve  sensibility ;  and  that  im- 
pressions of  stimuli  were  primarily  made  on  sentient  nerve 
matter. 

The  more  immediate  followers  of  Haller  regarded  his 
irritability  as  a  vis  vita;,  or  susceptibility  inherent  in  liv- 
ing organized  matter,  but  causing  motion  or  active  phe- 
nomena of  life  only  when  acted  upon  by  irritants  or  stim- 
uli. 

By  some  of  the  leading  chemists  oxygen  was  thought  to 
be  the  essential  excitor  or  irritant.  Others  claimed  that 
it  was  caloric  or  free  heat.  Still  others,  like  Galvani, 
claimed  that  galvanism  was  the  true  vital  force,  the  positive 
pole  being  identical  with  irritability  and  the  negative  with 
sensibility. 

Those  who  adhered  to  the  doctrine  that  ner^-e  struc- 
tures were  the  exclusive  seat  of  vital  susceptibility  called 
it  a  "nervous  force"  or  "life  giving  element",  and  claimed 
that  it  originated  in  the  brain  and  spinal  cord,  from  which 
it  was  transmitted  to  all  other  parts  of  the  body  by  the 
nerve  cords  and  the  blood. 

The  most  eminent  and  influential  advocate  of  the  neu- 
rologic pathology  was  William  Cullen,  professor  in  the 
University  of  Edinburgh.  He  was  born  in  Lanarkshire, 
Scotland,  in  1712,  of  ver}-  poor  parents,  and  obliged  to 
work  his  own  w-ay  to  an  education  and  high  position  in  his 
profession.  His  occupations  were  successively  those  of  a 
barber,  apothecary,  ship-surgeon,  and  then  the  surgeon  of 
a  small  village. 

He  was  an  intimate  friend  of  William  Hunter,  and  it 
is  said  they  alternated  as  practising  physicians  in  Hamil- 
ton ;  one  attending  to  the  practice  and  earning  the  nec- 
essary money  for  their  support,  w^hile  the  other  attended 
the  University.  By  such  means  Cullen  was  enabled  to 
graduate  in  1740,  and  six  years  later  he  was  appointed 
professor  of  chemistr\'  in  Glasgow.  In  175 1,  he  was  trans- 
ferred to  the  chair  of  Practice,  and  in  1756,  he  was  called 


109 

to  corresponding  positions  in  the  University  of  Edinburgh, 
where  he  remained  until  his  death,  in  1790. 

He  embraced  fully  the  doctrine  of  a  "nervous  force", 
or  susceptibility,  and  that  all  the  causes  of  disease  made 
their  primary  impression  on  the  nervous  system  produc- 
ing either  spasm  or  atony.  The  more  irritant  or  exciting 
causes  produced  direct  spasm  of  the  peripheral  vessels 
crowding  more  blood  upon  the  heart  and  internal  organs, 
followed  by  reaction  and  fever.  The  more  depressing  in- 
fluences caused  atony  of  the  vessels  primarily  and  conse- 
quent retarded  circulation,  to  be  followed  by  reaction  as 
in  the  other  case. 

In  1769  he  published  his  "Synopsis  Nosologse  Metho- 
dicae",  in  which  he  divided  all  diseases  into  four  classes, 
viz:  I.  Pyrexiae,  with  five  orders;  II.  Neuroses,  with  four 
orders  ;  III.  Cachexiae,  with  three  orders  ;  and  IV.  Locales, 
with  seven  orders.  Fevers,  constituting  the  first  order  of 
the  first  class,  he  divided  into  intermittents  or  periodical, 
and  continued.  The  latter  he  divided  into  Synocha,  Syno- 
chus  and  typhus. 

His  "First  Lines  of  the  Practice  of  Physic"  was  pub- 
lished in  1777;  and  a  "Treatise  on  Materia  ^Medica"  in 
1789.  Both  these  works  were  written  in  the  English  lan- 
guage, and  he  was  one  of  the  first  medical  professors  in 
Great  Britain  to  give  his  lectures,  both  didactic  and  clin- 
ical, in  his  native  language,  instead  of  the  orthodox  Latin. 

The  nosology  and  chief  pathological  doctrines  of  Cul- 
len  were  approved  by  a  large  proportion  of  the  profession 
in  Europe,  and  by  a  still  larger  proportion  in  the  English 
colonies  in  America,  among  whom  were  many  who  had 
'  received  their  chief  medical  instruction  in  Edinburgh  and 
subsequently  became  the  founders  of  the  first  medical 
schools  in  America.  The  therapeutic  agents  relied  upon 
by  Cullen  and  his  followers  were  rest,  low  diet,  cooling 
drinks,  cathartics,  and  sometimes  emetics,  opium  and  ven- 
esection in  the  earlier  stages,  and  later,  cinchona  bark 
and  wine,  with  more  nourishment.  IMercury,  in  the  form 
of  mild  chloride,  was  used  both  as  a  cathartic  and  altera- 


no 

tive,  especially  in  the  more  active  cases  of  inflammation 
and  fever. 

Perhaps  the  most  prominent  of  the  direct  followers  of 
Cullen  were  James  Gregory,  his  successor  in  the  Univer- 
sity of  Edinburgh,  Samuel  Bard,  of  New  York,  and  John 
Morgan,  of  Philadelphia,  who  were  professors  of  Prac- 
tice of  Medicine  in  the  first  two  medical  schools  founded 
in  America. 

Chief  among  those  who  were  influential  in  the  field  of 
Practical  Medicine  on  the  continent  of  Europe  were  Ger- 
hard von  Swieten,  of  Leyden,  who  later  went  to  Austria ; 
Anton  de  Haen,  of  the  Hague,  who  became  a  co-laborer 
with  von  Swieten  in  Vienna ;  Maximilian  Stoll,  of  Swabia, 
who  devoted  much  time  to  the  study  of  epidemics ;  Theo- 
phile  de  Borden,  of  Paris,  who  advocated  the  doctrine  of 
"vitaUsm"  and  defended  the  practice  of  inoculation ;  and 
J.  B.  T.  Baumes,  of  Montpellier,  who  endeavored  to  con- 
struct a  purely  chemical  system  of  medicine  and  divided 
all  diseases  into  five  classes,  i.  e.,  the  oxygenized,  the  calo- 
rified,  the  hydrogenized,  the  nitrogenized,  and  the  phos- 
phorized. 

But  the  physician  during  the  last  part  of  the  eighteenth 
century  whose  medical  doctrines  attracted  the  widest  at- 
tention was  John  Brown,  the  author  of  the  well  known 
Brunonian  system  of  medicine.  He  was  bom  in  Ber- 
wickshire, Scotland,  in  1735,  and  died  in  1788.  His  father 
was  a  poor  weaver  and  unable  to  give  the  son  a  liberal 
education.  But  young  Brown  manifested  a  remarkable 
degree  of  intellectual  activity  at  a  very  early  age,  and  after 
working  his  way  through  the  primary  and  Latin  schools 
he  entered  upon  the  study  of  medicine  as  a  pupil  of  Cul- 
len. At  the  same  time  he  became  a  friend  and  comrade 
of  Burns,  the  poet,  and  a  partaker  of  some  of  his  vicious 
habits.  Being  favored  by  Cullen  he  was  enabled  to  pursue 
his  studies  in  the  medical  school  in  Edinburgh,  but  finally 
received  the  degree  of  M.  D.  from  the  University  of  St. 
Andrew  in  1779.  As  early  as  1770,  however,  his  irregu- 
lar habits  caused  an  interruption  of  his  friendship  with 
Cullen.  and  he  commenced  giving  private  lectures,   set- 


Ill 


ting  forth  doctrines  in  many  respects  antagonistic  to  those 
cf  Cullen.  They  were  attended  by  many  students  and 
members  of  the  profession,  and  in  1780,  was  pubhshed  his 
celebrated  work  entitled  "Elementa  Medicinse".  Eight 
years  later  he  died  from  the  effects  of  alcoholic  drinks  and 
opium,  leaving  a  wife  and  children  destitute  of  the  neces- 
saries of  life— a  striking  illustration  of  the  fact  that  no 
activity  or  breadth  of  intellect  without  moral  integrity, 
can  safeguard  the  man  against  the  seductive  and  destruc- 
tive influence  of  these  anaesthetic  and  narcotic  drugs. 

Brown's  whole  theory  of  disease  was  founded  on  the 
assumption  that  living  matter  possessed  a  vital  irritabil- 
ity and  all  active  phenomena  of  life  resulted  from  the  ac- 
tion of  stimuli  on  this  irritability.  In  other  words,  life 
was  simply  a  state  of  excitation.  When  from  natural  stim- 
uli, as  air,  water  and  food  in  proper  quantities,  health  was 
the  result.  When  the  stimuU  were  in  excess  or  deficiency, 
or  irritating  in  quality,  disease  was  the  result.  If  the  stim- 
uli were  deficient  or  depressing  the  resulting  disease  was 
termed  asthenic,  if  in  excess  or  too  active  the  result  was 
sthenic.  The  resulting  changes  in  structure  were  termed 
congestion,  irritation  and  inflammation.  His  therapeutic 
principles  were  equally  simple  and  easily  applied.  His  doc- 
trines found  but  few  followers  in  England,  but  became 
quite  popular  on  the  continent,  and  found  some  influen- 
tial advocates  in  America. 

Preventive  Medicine:  The  inoculation  of  young 
persons  in  good  health  with  the  virus  of  variola  (small- 
pox) for  the  purpose  of  securing  mildness,  and  there- 
fore safety,  in  the  attack,  as  well  as  permanent  exemption 
from  future  attacks,  was  practised  by  the  Brahmans  of 
India,  and  by  the  Chinese,  at  least  1,000  years  before  the 
Christian  era.  But  it  was  not  known  or  practised  in 
Europe  or  this  country  until  the  beginning  of  the  eigh- 
teenth century.  The  first  account  of  this  practice  in  Asia 
was  given  by  Emanuel  Timoni,  a  physician  residing  in 
Constantinople,  in  a  communication  to  the  Royal  Society 
of  London,  in  1 714.  In  171 7  Lady  Mary  Wortley  Montague, 
the  wife  of  the  English  Ambassador  to  the  Porte,  had  her  son 


112 

inoculated,  and,  on  her  return  to  London  in  1721,  she  had 
her  daughter,  aged  six  years,  inoculated.  These  proving 
favorable,  a  son  of  Dr.  Keith  was  inoculated  the  same  year, 
and  soon  after  several  members  of  the  royal  family.  The 
Rev.  Cotton  Mather,  of  New  England,  having  read  the 
published  papers  of  Timoni  to  the  Royal  Society  of  Lon- 
don in  1714,  induced  Dr.  Zabdiel  Boylston,  of  Boston,  to 
inoculate  his  own  son,  thirteen  years  old,  and  two  colored 
servants,  the  27th  of  June,  1721,  only  two  months  after 
the  inoculation  of  the  daughter  of  Lady  Montague  in  Lon- 
don. These  cases  proving  successful.  Dr.  Boylston  the 
same  year  inoculated  247  persons  of  different  ages  and 
39  were  inoculated  by  other  physicians,  making  286,  of 
which  6  died,  while  of  5,759  who  were  attacked  in  the  nat- 
ural way  the  same  year  844  died.  From  these  beginnings 
in  London  and  Boston  the  practice  of  inoculation  spread 
rapidly  in  both  Europe  and  America,  but  not  without  much 
and  sometimes  bitter  opposition.  It  was  practised  espe- 
cially in  the  armies  of  the  different  countries  to  prevent  the 
disastrous  consequences  of  a  small-pox  epidemic  in  the 
midst  of  an  active  campaign. 

During  the  American  revolution  from  1 775-1 781,  many 
of  the  newly  recruited  regiments  were  placed  in  camps 
under  good  hygienic  regulations  and  subjected  to  inocula- 
tion generally  with  a  resulting  mortality  of  only  one  in 
700  or  800. 

Though  this  practice  greatly  lessened  the  aggregate 
mortality  from  small-pox  during  the  last  half  of  the 
eighteenth  century  it  was  destined  to  be  soon  superseded 
by  the  discovery  of  the  preventive  power  of  vaccination 
with  the  cow-pox  virus  by  Edward  Jenner,  of  Berkeley, 
Gloucestershire,  England,  and  published  to  the  world  in 

1798. 

Jenner  was  born  in  1749  and  died  in  1823.  After  re- 
ceiving a  good  academic  education  he  decided  to  study 
medicine,  and  entered  the  office  of  surgeon  Ludlow,  of 
Sudbury,  near  Bristol,  as  an  apprentice.  Among  the  pa- 
tients visiting  the  surgeon's  office  was  a  milk-maid  who 
had   previously   had   a   pustule    on  her   hand    caused   by 


113 

matter  from  sores  on  the  udder  of  a  cow  while  milk- 
ing, and  which  it  was  claimed  rendered  her  immune  to 
small-pox.  Learning  that  several  such  cases  had  been 
noticed  among  milk-maids,  the' thought  occurred  to  him 
that  if  the  sore  on  the  udder  of  the  cow  from  which 
the  virus  was  communicated  to  some  abrasion  on  the 
finger  or  hand  of  the  milk-maid  could  be  identified,  and 
a  way  devised  for  propagating  it  in  sufficient  quantity 
for  use  for  general  vaccination  instead  of  the  virus  of 
small-pox,  it  would  be  a  great  boon  to  the  human 
race.  In  1770,  he  went  to  London  and  became  a  pupil 
of  John  Hunter.  While  studying  with  him  he  talked 
freely  about  the  possibility  of  discovering  and  propagating 
the  cow-pox  virus  and  using  it  for  the  prevention  of  small- 
pox and  he  was  advised  by  Hunter  to  investigate  the 
subject  more  thoroughly.  When  his  term  of  study  had 
been  completed  he  returned  to  Berkeley  and  commenced 
the  practice  of  his  profession,  because  it  was  in  a  dairy 
district,  favorable  for  the  prosecution  of  the  investiga- 
tion that  had  been  so  strongly  impressed  upon  his  mind. 
With  untiring  perseverance  he  prosecuted  his  inquiries 
and  experiments  for  twenty  years,  and  in  1796  he  vaccinated 
his  first  human  subject,  James  Phipps,  with  virus  from  a 
cow-pox  pustule  on  the  hand  of  Sarah  Nelnies  contracted 
while  milking.  Subsequently  both  Phipps  and  Nelmes 
were  found  to  be  completely  immune  to  inoculations  with 
small-pox  virus.  With  the  virus  from  these  cases  he  con- 
tinued to  vaccinate  others  until  the  proofs  of  the  value  of 
his  discovery  were  fully  established,  when  in  1798  he  pub- 
lished to  the  world  a  full  account  of  his  work  in  a  paper 
entitled  "An  Inquiry  into  the  Causes  and  Effects  of  the 
Variola  Vaccina".  The  paper  was  soon  translated  into 
several  of  the  European  languages  and  circulated  freely  in 
most  of  the  countries  of  Europe  and  in  America. 

The  first  vaccinations  in  America  were  made  by  Ben- 
jamin Waterhouse,  of  Boston,  Professor  of  the  Practice 
of  Medicine  in  Harvard  College ;  who  procured  virus  from 
Dr.  Haygarth,  of  Bath,  England,  and  vaccinated  four  of 
his  own  children  in  July,  1800. 


114 

*  Thus  was  given  to  the  world  with  the  utmost  free- 
dom and  frankness  on  the  part  of  its  author — perhaps  the 
greatest  life-saving  discovery  known  in  the  history  of  pre- 
ventive medicine.  Its  reception,  rapid  diffusion,  and  ulti- 
mate eflects  upon  its  discoverer  will  belong  to  the  early 
years  of  the  nineteenth  century. 

Another  great  advance  in  the  prevention  of  human 
suffering  was  commenced  by  Philippe  Pinel  in  charge  of 
the  Hospital  Eicetre,  in  Paris,  in  1792,  and  subsequently 
by  the  Salpetriere.  It  was  while  in  charge  of  the  Bicetre, 
that  he  boldly  removed  the  chains  from  many  of  the  in- 
sane patients,  and  instituted  that  more  humane  and  suc- 
cessful treatment  which  has  since  met  with  universal  ap- 
proval. 


115 


CHAPTER  IX. 

HISTORY  OF  MEDICINE  DURING  THE  FIRST  HALF  OF  THE  NINE- 
TEENTH CENTURY. 


Discoveries  in  the  Physiology  of  the  Nervous  System;  in 
Pathological  Anatomy;  Physical  Diagnosis;  and  Organic 
Chemistry.  The  Discovery  of  Anaesthesia ;  and  the  Prac- 
tice of  Ovariotomy. 


As  was  shown  in  the  two  preceding  chapters,  the  chief 
important  and  permanent  improvements  in  the  several 
branches  of  medicine  during  the  eighteenth  century  were 
the  rapid  advancement  of  inorganic  and  analytical  chem- 
istry, with  the  laws  governing  chemical  combinations  and 
the  addition  of  electricity  and  galvanism;  the  addition  of 
general  anatomy  by  Bichat,  and  minute  anatomy  by  aid  of 
the  microscope ;  the  development,  of  human  physiology  un- 
der the  leadership  of  Albert  Von  Haller;  and  the  discovery 
of  the  protective  power  of  vaccination  with  cow-pox  lymph 
by  Edward  Jenner.  The  last  named  discovery  was  announced 
to  the  world  during  the  last  years  of  the  eighteenth  century, 
(1798)  and  was  met  with  much  adverse  criticism  and  some 
bitter  denunciations.  But  so  complete  were  the  proofs  pa- 
tiently gathered  by  Jenner,  that  his  work  at  once  command- 
ed the  attention  of  the  more  enlightened  members  of  the 
profession  in  Europe  and  America ;  and  as  fast  as  samples 
of  the  cow-pox  lymph  could  be  obtained  it  was  put  to  the 
test.  This  resulted  in  so  rapid  an  establishment  of  its  effi- 
cacy that  before  the  close  of  the  year  1800  it  had  been  ap- 
proved and  successfully  introduced  into  London,  Vienna, 
Paris,  Berlin,  Saxony,  St.  Petersburg,  and  in  Boston,  Bal- 
timore, and  several  other  cities  of  the  United  States.  So 
complete  was  the  general  approval  of  this  most  valuable 
discovery,  that  in  1802  the  British  government  awarded  Dr. 
Jenner  the  sum  of  $50,000,  and  four  years  later  the  further 
sum  of  $100,000;  and  a  few  years  later  still,  he  received 
awards   from  the  presidencies   of    Bengal,    Bombay    and 


ii6 

Madras  aggregating  $35,000.  In  1808  he  was  elected  a  cor- 
responding member  of  the  National  Institute;  and  in  1857 
a  monument  was  erected  to  his  memory  in  Trafalgar  Square, 
London.  Notwithstanding  the  general  adoption  of  the  Jen- 
nerian  vaccination  as  a  safe  and  effectual  preventive  of  small- 
pox by  the  people  and  governments  of  all  civilized  countries, 
there  still  remains  a  small  class  of  bitter  opponents,  called 
anti-vaccinationists. 

Progress  of  Chemistry.  During  the  firsthalf  of  the  nine- 
teenth century  inorganic  chemistry  continued  its  rapid  prog- 
ress by  the  labors  of  Barthollet,  Thenard,  Vauquelin,  Proust, 
Dumas,  Magendie  and  Orfila  of  France ;  Berzelius,  in 
Sweden ;  Hofifman,  Richter,  Gmelin,  and  Schoenbien,  in  Ger- 
many ;  Dalton,  Davy,  Faraday  and  Graham,  in  England ; 
and  Benjamin  Silliman  of  the  United  States.  But  the  crown- 
ing event  in  the  progress  of  chemistry  during  this  half  cen- 
tury, was  the  development  of  organic  and  physiological 
chemistry  by  Justus  Liebig,  of  Germany,  in  his  monograph, 
first  presented  to  the  British  Provincial  Medical  and  Sur- 
gical Association  and  published  in  1842,  under  the  title,  "Or- 
ganic Chemistry  in  its  Relations  to  Physiolog}'  and  Pathol- 
ogy," One  or  two  years  previously  he  had  published  a  work 
on  "Chemistry  in  its  Relations  to  Agriculture",  which  at- 
tracted much  attention  both  in  Europe  and  America.  In 
these  publications  he  endeavored  to  explain  all  the  phenom- 
ena of  vegetable  and  animal  life  in  accordance  with  purely 
chemical  laws.  Analysis  having  shown  that  all  organized 
bodies  were  composed  either  of  four  elements,  i.  e.,  carbon, 
hydrogen,  oxygen  and  nitrogen,  or  of  the  first  three  ele- 
ments named  only.  He  called  the  first,  nitrogenous  elements, 
and  the  second,  non-nitrogenous  or  carbonaceous.  The  same 
analytical  examination  of  the  various  food  substances  showed 
them  to  be  composed  of  the  same  two  classes  of  matter.  Con- 
sequently Liebig  claimed  that  the  nitrogenous  food  elements 
were  used  for  the  growth  and  repair  of  the  organized  struc- 
tures of  the  body,  while  the  carbonaceous,  or  hydro-carbons, 
were  oxidized  for  the  production  of  heat  or  stored  in  the 
form  of  fat.  In  the  first  class  of  food  substances  he  included 
the  fibrinous  and  albuminous  parts  of  animals,  including 


117  ■ 

eggs,  the  casein  of  milk,  and  the  gluten  in  cereals  or  grain. 
In  the  second  class  he  included  the  fats  or  oils,  the  starch, 
sugar,  gum,  and  the  alcohols ;  all  of  which  were  supposed 
to  unite  with  the  oxygen  furnished  by  respiration,  constitut- 
ing a  form  of  combustion  for  the  maintenance  of  animal  heat 
and  force.  When  they  were  consumed  too  rapidly,  evolving 
heat  in  excess,  fever  was  produced.  If  they  were  taken 
faster  than  they  could  be  oxidized  or  burned  up,  they  were 
stored  in  some  of  the  tissues  in  the  form  of  fat.  As  proof 
of  the  correctness  of  his  theory,  he  claimed  that  the  inhab- 
itants of  the  colder  regions  of  the  earth  consumed  much  more 
of  the  non-nitrogenous  or  combustible  food  than  the  inhab- 
itants of  the  tropical  regions. 

These  views  and  classifications  of  Liebig  were  so  plausi- 
ble and  so  easily  comprehended  that  they  were  very  gen- 
erally adopted,  and  very  soon  became  incorporated  into  all 
our  literature,  both  professional  and  secular.  Their  correct- 
ness, however,  was  denied  by  some  of  his  contemporaries, 
among  whom  were  Lehman,  Miescher  and  Voit,  in  Germany ; 
Sandras  and  Bouchardet,  of  France ;  William  Prout,  of  Eng- 
land, and  myself  in  this  country,  as  will  be  seen  in  the  sequel. 

Directly  parallel  with  the  progress  of  both  organic  and 
general  chemistry,  came  the  brilliant  'discovery  of  Sir  Charles 
Bell,  of  London,  concerning  the  distinct  sensory  and  motor 
functions  of  the  posterior  and  anterior  roots  of  the  spinal 
nerves  and  their  connections,  published  in  1824;  the  experi- 
ments of  James  H.  Miller,  of  Baltimore,  Md. ;  M.  Brachet, 
of  France,  and  Professor  Reid,  of  the  British  Association  of 
Science,  concerning  the  functions  of  the  great  sympathetic 
or  ganglionic  system  of  nerves,  between  1809  ^^'^  1838;  the 
work  of  Marshall  Hall  in  demonstrating  the  reflex  or  excito- 
motor  system  of  nerves  as  published  in  1838 ;  and  experi- 
ments to  determine  the  special  function  of  dififerent  parts  of 
the  brain  and  medulla  oblongata,  by  Magendie,  Flourens, 
Reid,  H.  H.  Smith,  of  Philadelphia,  and  others. 

The  researches  of  all  the  foregoing  investigators  in  the 
field  of  nerve  physiology  were  well  supplemented  by  the 
very  valuable  work  of  Dr.  Samuel  George  Morton,  of  Phila- 
delphia, entitled  "Crania  Americanae",  published  in  1839. 


ii8 

The  experiments  of  Sir  Charles  Bell  fully  demonstrating 
that  the  posterior  columns  of  the  spinal  cord  and  the  nerves 
proceeding  therefrom  were  sensory  in  their  function,  and  the 
anterior  columns,  and  the  nerves  connected  therewith,  were 
motor,  were  performed  in  1816.  By  subsequent  experiments 
he  demonstrated  the  connection  of  the  nerves  controlling  res- 
piration with  the  medulla  oblongata. 

The  investigations  of  James  H.  Miller,  of  Baltimore, 
were  commenced  in  1809  and  prosecuted  until  he  fairly  dem- 
onstrated the  important  functions  of  the  great  sympathetic 
or  abdominal  plexuses  of  nerves,  and  taught  the  same  in  his 
lectures  in  Washington  Medical  College  in  1827,  a  few  years 
previous  to  the  publication  of  M.  Brachet's  researches  con- 
cerning the  same  subject  in  France.  Later  Marshall  Hall, 
by  additional  experimentation,  found  that  not  only  the 
nerves  of  respiration,  but  also  those  of  the  organs  of  circula- 
tion, had  their  center  in  the  medulla  oblongata,  and  claimed 
these,  together  with  the  nerves  controlling  the  sphincter 
muscles  of  the  body,  as  constituting  a  distinct  system  called 
"excito-motory".  The  results  of  his  investigations  were  pre- 
sented in  a  communication  to  the  Royal  Society  in  1833. 

While  the  foregoing  developments  in  organic  chemistry 
were  taking  place  in  Germany,  and  the  discoveries  in  the 
physiology  of  the  nervous  system,  chiefly  in  England  and 
America,  a  no  less  important  evolution  of  pathological  an- 
atomy and  physical  diagnosis  was  in  progress,  chiefly  in 
France.  From  the  study  of  the  normal  tissues  of  the  body  by 
Bichat  in  the  closing  years  of  the  eighteenth  century,  it  was 
a  natural  step  in  progress  to  investigate  the  same  tissues  in 
the  different  stages  of  disease.  For  this  purpose  the  Parisian 
hospitals  La  Charite  and  Hotel  Dieu,  afforded  the  best  op- 
portunities, and'  the  leading  physicians  engaged  in  the  work 
were  Bayle,  Corvisart,  Laennec,  Chomel,  Louis,  Andral  and 
Gavarret. 

Jean  Nicolas  Corvisart  was  born  in  1755,  a  native  of 
Dricourt  in  Champagne.  He  studied  medicine  in  Paris  as  a 
pupil  of  Vicq  d'Azyrand  Petit;  and  in  1795  was  made  Pro- 
fessor of  ^Medicine  in  the  clinic  of  the  Charite  Hospital.  Sub- 
sequently he  became  successively  ordinary  physician  of  the 


119 

First  Consul,  and  then  of  the  Emperor  Napoleon.  Notwith- 
standing these  official  relations  he  found  time  to  investigate 
minutely  the  pathological  changes  in  different  stages  of  dis- 
eases of  the  heart  and  lungs.  In  1808  he  translated  from  the 
German  Auenbrugger's  work  on  percussion  as  a  means  for 
the  diagnosis  of  diseases  within  the  chest,  and  in  his  hospital 
clinics  was  perhaps  the  first  to  apply  the  ear  to  the  naked 
chest  (immediate  auscultation)  in  studying  the  sounds  of 
the  heart.  He  published  a  valuable  work  on  diseases  of  the 
heart,  and  aided  Bayle  and  Laennec  in  studying  pulmonary 
tuberculosis.  He  gained  a  very  high  reputation  for  integrity 
and  kindness,  which  added  much  to  his  influence. 

Gaspard  Laurent  Bayle  studied  medicine  in  Montpellier, 
and  after  several  years  of  service  in  connection  with  the 
army  he  became  one  of  the  physicians  to  the  Charite  Hospital 
in  Paris,  where  he  and  Laennec  conducted  numerous  post- 
mortem examinations  of  those  who  had  died  from  pulmonary 
consumption.  Bayle  accurately  described  the  gray  miliary 
tubercle,  and  Laennec  described  the  several  stages  of  tuber- 
cular infiltration. 

To  these  were  added  the  results  of  dissections  of  no  less 
than  358  bodies  dead  from  pulmonary  consumption  by  M. 
Louis,  from  which  he  obtained  descriptions  of  the  tubercular 
disease  in  every  stage  of  its  progress.  But  the  most  im- 
portant work  of  both  MM.  Chomel  and  Louis  was  in  tracing 
the  structural  changes  taking  place  in  the  abdominal  viscera 
during  the  progress  of  continued  fevers,  which  up  to  their 
time  had  been  called  typhus  or  adynamic  fevers.  They  soon 
pointed  out  with  great  accuracy  the  visible  changes  in  the 
liver,  spleen  and  the  glandular  structures,  in  the  mucous 
membrane  of  the  intestines,  and  those  in  the  mesentery. 
They  found  in  some  cases  progressive  enlargement  and  soft- 
ening of  the  liver  and  spleen,  tumefaction  and  softening  of 
the  mesenteric  glands,  and  enlargement  and  ulceration  of  the 
glands  of  Peyer  and  Brunner,  more  especially  in  those  of  the 
lower  half  of  the  ileum  and  its  connection  with  the  colon, 
and  in  the  middle  and  advanced  stages  much  gaseous  dis- 
tension of  the  intestines.  In  other  cases  they  found  much 
less  change  in  the  glands  of  the  intestines  and  mesentery, 


120 

less  abdominal  tympanitis,  and  more  softening  of  the  struc- 
tures of  the  spleen  and  heart,  with  darker  color  and  less 
coagulability  of  the  blood.  Louis,  adopting  a  numerical 
method,  placed  all  those  presenting  the  first  assemblage  of 
pathological  events  in  one  series,  calling  them  cases  of  ab- 
dominal typhus ;  those  presenting  the  symptoms  named  in 
the  second  series  he  called  simply  cases  of  typhus.  Both  he 
and  his  co-workers,  however,  found  a  less  number  of  cases 
in  which  the  pathological  changes,  both  in  the  viscera  and 
on  the  cutaneous  surface,  were  so  mixed  that  they  were 
obliged  to  make  a  third  series  called  doubtful. 

While  these  investigations  were  being  prosecuted  in 
Paris,  the  same  methods  of  clinical  and  post-mortem  study 
by  Gerhard,  of  Philadelphia,  Enoch  Hale  and  J.  Jackson,  of 
Boston,  and  Austin  Flint,  then  of  Buffalo,  all  of  whom  had 
been  visitors  in  Paris,  were  being  pursued  in  the  several 
cities  named.  The  same  line  of  study  concerning  the  patho- 
logical changes  in  the  cases  of  continued  fever  in  the  Lon- 
don hospitals  was  also  pursued  by  Sir  William  Jenner,  and 
with  the  same  results.  An  account  of  the  work  of  Enoch 
Hale  was  published  in  1833;  that  of  Gerhard  in  1835;  of 
M.  Louis  in  1841 ;  of  Sir  William  Jenner  in  1850;  and  of 
A.  Flint  in  1852. 

In  the  meantime,  while  the  foregoing  investigators  were 
pursuing  their  studies  concerning  the  pathological  changes 
that  take  place  in  the  various  organized  structures,  MM. 
Andral  and  Gavarret  of  Paris  were  making  equally  patient 
investigations  chemically  concerning  the  changes  in  the 
pathological  conditions  of  the  blood,  the  secretions  and  ex- 
cretions in  all  the  more  important  febrile  and  inflammatory 
affections,  which  resulted  in  the  publication  by  Andral  of 
his  valuable  "Essay  on  the  Pathology  of  the  Blood"  in  1843. 
His  work  showed  conclusively  that  in  all  acute  general  dis- 
eases the  blood  and  other  fluids  of  the  body  suffered  changes 
both  in  composition  and  quality  as  important  as  those  in  the 
organized  structures,  and  thereby  checked  the  exclusive 
solidistic  doctrine  that  had  followed  the  discovery  of  the  ir- 
ritability of  Haller  and  the  neurology'  of  Cullen. 

Physical  Diagnosis:    During  the  progress  of  all  the 


121 


foregoing  pathological  investigations,  efforts  were  made  to 
determine  the  connection  of  each  change  with  diagnostic 
symptoms  marking  the  successive  stages   of  the   disease. 
Bayle  and  Laennec,  in  their  clinics,  had  not  only  revived  the 
practice  of  percussion  as  first  taught  by  Auenbrugger,  but 
they  had  also  practised  immediate  auscultation,  that  is,  the 
direct  application  of  the  ear  to  the  chest  for  detecting  the 
sounds  produced  by  movements  of  the  heart  and  lungs.    To 
facilitate  listening  over  any  and  all  parts  of  the  chest,  Laen- 
nec constructed  a  tube  of  cedar  wood,  with  an  ear  piece  at 
one  end  and  a  funnel-shaped  opening  at  the  other,  which 
was  called  a  stethoscope.    The  invention  attracted  much  at- 
tention, and  greatly  increased  the  practice  of  auscultation  and 
percussion  to  aid  in  the  diagnosis  of  diseases  in  the  chest. 
In  1819  was  published  his  work,  "De  I'Auscultation  Mediate, 
ou  Traite  du  Prognostic  des  Maladies  des  Poumons  et  du 
Coeur,  etabli  principalment  a  I'aide  de  ce  nouveau  Moyen 
d'Exploration."    This  was  soon  translated  into  most  of  the 
languages  of  Europe,  and  rapidly  extended  the  practise  of 
physical  exploration  as  an  aid  in  diagnosis,  and  added  much 
to  his  reputation.     But  the  next  year  his  health  began  to 
fail  and  he  died  from  pulmonary  tuberculosis  in  1826,  at  the 
age  of  forty-five  years. 

The  pleximeter,  for  aiding  in  the  practice  of  percussion, 
was  invented  by  P.  A.  Piorry,  of  Paris,  in  1826 ;  and  he  ex- 
tended its  use  to  the  abdomen  as  well  as  to  the  thorax. 

The  practice  of  physical  diagnosis  of  the  French  was  in- 
troduced into  the  German  states  and  Austria  by  Rokitansky 
and  Skoda,  of  Vienna ;  into  Great  Britain  by  John  Forbes, 
William  Stokes  and  C.  J.  B.  Williams ;  and  into  America  by 
James  Jackson  Jr.,  of  Boston,  W.  W.  Gerhard  and  Samuel 
George  Morton,  of  Philadelphia,  and  Austin  Flint,  Alonzo 
Clark  and  G.  P.  Camman,  of  New  York. 

Both  the  stethoscope  of  Laennec  and  the  pleximeter  of 
Piorry  underwent  many  modifications  by  different  parties 
in  different  countries ;  the  most  important  of  which  was  the 
completed  binaural  stethoscope  of  Dr.  Camman  of  New  York 
in  1852.  During  my  three  years  of  medical  study  from  1834 
to  1837  I  received  no  instruction  in  the  practice  of  ausculta- 


122 

tion,  but  was  told  by  the  professor  of  practical  medicine  that 
a  stethoscope  had  been  invented  by  Laennec  and  he  thought 
it  would  be  found  useful.  I  accordingly,  the  same  year, 
purchased  a  plain  primitive  cedar  wood  instrument,  and  a 
few  years  later  one  of  Dr.  Camman's  more  perfect  binaural 
stethoscopes. 

Anesthesia  :  One  of  the  most  important  discoveries  in 
the  history  of  medicine  was  made  during  the  last  decade  of 
the  first  half  of  the  nineteenth  century  by  members  of  the 
medical  profession  in  the  United  States  of  America.  During 
the  last  three  or  four  centuries  narcotics  and  alcoholic  liquors 
had  frequently  been  administered  to  patients  to  lessen  the 
severity  of  their  pains  during  surgical  operations,  and  Sir 
Humphrey  Davy  had  vaguely  suggested  that  the  inhalation 
of  nitrous  oxide  gas  might  be  found  useful  for  the  same 
purpose.  The  first  direct  experiments  for  producing  com- 
plete anaesthesia,  or  unconsciousness  of  pain  for  surgical  pur- 
poses, however,  were  made  by  Horace  Wells,  a  practitioner 
of  dentistry  in  Hartford,  Connecticut,  in  1840.  He  was  a 
native  of  that  State,  born  in  181 5.  After  several  times  dem- 
onstrating his  ability  to  render  a  patient  insensible  to  pain 
by  the  inhalation  of  nitrous  oxide  gas,  he  extracted  teeth 
without  pain  under  its  influence,  in  Hartford,  Dec.  nth, 
1844.  During  the  next  month,  January,  1845,  he  caused  the 
inhalation  of  sulphuric  ether  vapor  while  Dr.  Marcy  removed 
a  tumor  (wen)  from  the  head  of  a  patient  without  pain  or 
consciousness.  During  the  same  month  he  communicated 
these  facts  to  the  medical  and  surgical  stafif  of  the  Massa- 
chusetts General  Hospital  in  Boston,  and  attempted  to 
anaesthetize  a  patient  for  an  operation  before  a  class  in  at- 
tendance. 

From  mental  trepidation  and  over-anxiety  he  failed  to 
effect  complete  anaesthesia,  and  was  hooted  out  by  the  stu- 
dents as  a  failure.  He,  however,  continued  to  extract  teeth 
under  the  successful  anaesthetic  effects  of  both  the  nitrous 
oxide  and  ether,  which  was  well  known  to  both  Charles  T. 
Jackson  and  Dr.  W.  T.  G.  Morton,  of  Boston.  The  latter 
had  been  a  student  of  Dr..  Wells  and  was  a  practitioner  of 
dentistr}\    Dr.  Jackson  was  an  eminent  chemist  and  well  ac- 


123 

quainted  with  the  effects  of  inhaHng  ether,  though  he  had 
made  no  attempt  to  apply  its  use  in  surgery.  In  October, 
1846,  Dr.  Morton  successfully  anaesthetized  a  patient  in  the 
Massachusetts  General  Hospital  with  ether,  while  Dr.  J.  C. 
Warren  performed  an  operation,  a  full  account  of  which  was 
published  in  the  Boston  Medical  and  Surgical  Journal,  No- 
vember 18,  1846.  Jackson  and  Morton  claimed  this  as  the 
first  demonstration  of  the  practicability  and  safety  of  surgical 
anaesthesia,  and  soon  obtained  a  patent  for  their  an<iesthetic 
under  the  fictitious  name  of  "Letheon."  This,  however,  was 
soon  shown  to  be  nothing  but  a  pure  specimen  of  sulphuric 
ether,  and  their  patent  became  void. 

Several  years  later  it  was  satisfactorily  shown  by  Dr.  J. 
Marion  Sims,  that  so  early  as  March  30,  1842,  Dr.  Crawford 
W.  Long,  of  Georgia,  had  safely  extirpated  a  tumor  from  the 
neck  of  a  Mr.  Venables  while  profoundly  under  the  anaes- 
thetic influence  of  ether.  And  during  the  next  three  years 
the  same  surgeon  performed  several  other  operations  with 
the  patients  under  the  complete  influence  of  the  same  an- 
aesthetic. But  he  published  no  account  of  his  work  un- 
til 1849. 

Chloroform  as  a  chemical  substance  was  discovered  in- 
dependently, and  nearly  at  the  same  time,  in  1831,  by  Mr. 
Samuel  Guthrie,  of  Sackett's  Harbor,  N.  Y.,  and  Soubeiran 
in  France.  Its  properties  were  studied  by  Liebig,  and  it  was 
named  chloroform  by  Dumas.  It  was  first  used  by  Sir  J.  Y. 
Simpson,  of  Edinburgh,  for  producing  anaesthesia  instead 
of  ether,  in  November,  1847. 

Such  is  a  simple  history  of  the  discovery  of  anaesthesia 
as  a  means  of  temporarily  preventing  or  relieving  pain  in 
the  practice  of  medicine,  surgery  and  midwifery,  as  produced 
by  the  three  leadmg  general  anaesthetics,  i.  e.,  nitrous  oxide, 
sulphuric  ether,  and  chloroform.  When  properly  used  it  is 
one  of  the  most  beneficent  discoveries  in  medical  history. 
At  first  its  use  met  with  much  opposition,  as  is  usual  with 
all  new  discoveries  of  importance.  This,  however,  soon 
ceased  and  was  .followed  by  a  tendency  to  abuse,  by  resort- 
ing to  it  on  trivial  occasions,  or  prolonging  its  effects  con- 
tinuously longer  than  necessary. 


124 

Ovariotomy  :  Another  advancement  of  much  impor- 
tance in  the  domain  of  operative  surgery,  during  the  first 
half  of  the  nineteenth  century,  was  the  deHberate  planning, 
and  the  successful  execution,  of  the  operation  of  ovariotomy 
by  Dr.  Ephraim  McDowell,  of  Danville,  Kentucky,  in  De- 
cember, 1809.  It  is  true  that  the  ovary  had  been  several 
times  removed  as  an  incidental  or  necessary  accompaniment 
of  operative  procedures  for  the  removal  of  other  parts,  but 
not  as  an  independent  operation  for  ovarian  disease.  The 
first  patient  operated  upon  by  Dr.  McDowell  was  a  Mrs. 
Crawford,  who  was  afflicted  by  an  ovarian  tumor,  and  he 
proceeded  to  deliberately  remove  it  without  the  aid  of  either 
anaesthetics  or  special  antiseptics,  for  at  that  time  neither  was 
used  or  known  to  the  profession.  The  patient  made  a  good 
recover}^  and  lived  in  fair  health  more  than  thirty  years  aft- 
erwards. He  performed  the  operation  in  all  thirteen  times, 
resulting  in  eight  complete  recoveries  and  five  failures.  A 
full  account  of  them  was  published  in  the  "Eclectic  Repos- 
itor}-  and  Analytic  Review"  for  April,  18 16. 

Dr.  McDowell  died  in  1830,  and  a  monument  was  erected 
to  his  honor  in  Danville,  Kentucky,  in  1879.  In  1831,  a 
single  ovariotomy  was  performed  by  Dr.  Nathan  Smith,  but 
no  one  ventured  to  follow  his  example  by  repeating  the  op- 
eration until  1843,  when  Dr.  John  L.  Atlee,  of  Lancaster, 
Pennsylvania,  successfully  removed  a  very  large  ovarium. 
The  following  year,  1844,  the  operation  was  repeated  with 
success  by  his  brother,  Dr.  Washington  L.  Atlee,  of  Phila- 
delphia, Pennsylvania ;  and  also  by  Dr.  Alexander  Dunlap, 
of  Springfield,  Ohio.  Edmund  Randolph  Peaslee,  of  New 
York,  performed  his  first  ovariotomy  in  1850,  at  which  time 
thirty-six  operations,  in  all,  had  been  performed  by  eighteen 
operators,  resulting  in  twenty-one  recoveries  and  fifteen 
deaths.  By  this  time,  however,  the  use  of  anaesthetics  had 
received  the  sanction  of  leading  surgeons,  obstetricians  and 
g}'necologists  on  both  sides  of  the  Atlantic,  and  greatly  en- 
couraged and  facilitated  the  performance  of  otherwise  for- 
midable surgical  operations  of  all  kinds.  But  at  this  early 
period  probably  no  one  except  the  originator,  Dr.  McDowell, 
exerted  more  influence  in  sustaining  the  propriety  and  dem- 


125 

onstrating  the  feasibility  of  ovariotomy  than  Washington  L. 
Atlee,  of  Philadelphia,  and  his  brother  John,  of  Lancaster, 
Pennsylvania.  And,  as  we  shall  see  in  the  sequel,  it  proved 
the  beginning  or  foundation  of  the  whole  system  of  modern 
abdominal  surgery. 

From  the  foregoing  review  of  the  discoveries  in  the 
physiology  of  the  nervous  system ;  the  development  of  patho- 
logical anatomy  and  physical  diagnosis ;  the  evolution  of  or- 
ganic chemistry  ;  the  discovery  of  true  anaesthesia  and  its  ap- 
plication to  the  prevention  or  relief  from  pain  in  all  the  prac- 
tical departments  of  medicine,  all  resulting  from  patient  ob- 
servation, experimental  research,  and  the  application  of 
known  scientific  principles  to  the  construction  of  new  instru- 
ments and  appliances,  we  see  a  more  rapid,  more  extensive 
and  more  important  enlargement  of  the  scientific  basis  of 
medicine,  during  the  first  half  of  the  nineteenth  century,  than 
during  any  previous  period  in  its  history.  It  was  the  first 
period  in  the  history  of  medicine  when  strictly  scientific  in- 
vestigations and  their  results  gained  predominance  and  gave 
a  decided  check  to  the  persistent  tendency  to  construct  so- 
called  schools  or  systems  of  medicine  on  theoretical  dogmas 
or  general  hypotheses. 

One  of  the  earliest  and  most  direct  effects  of  the  devel- 
opment of  organic  chemistry,  was  its  application  to  the  sep- 
aration of  the  active  constituents  of  crude  vegetable  drugs, 
and  of  the  pathological  changes  in  the  blood  and  secretions 
of  the  human  body  during  the  progress  of  disease.  The  lat- 
ter, as  we  have  already  seen,  was  begun  and  successfully 
'prosecuted  by  Andral  and  Gavarret,  in  Paris,  from  1833  to 
1843.  The  chemical  research  for  the  active  constituents  of 
opium,  nux  vomica  and  cinchona  bark  was  commenced  in 
1816,  when  morphia  was  separated  from  opium,  and  in  1818 
Pelletier  and  Caventou  obtained  strychnia  from  the  nux 
vomica,  and  in  1820  the  same  chemists  separated  quinia  from 
the  cinchona  bark.  So  much  interest  was  excited  in  this  line 
of  investigation,  that  in  1835  the  Society  of  Pharmacy  of 
Paris  offered  a  prize  of  500  francs  for  the  discovery  of,  and 
the  mode  of  preparation  of,  the  active  constituent  in  the 
digitalis  purpurea.     This  was  increased  in   1840  to   1,000 


126 

francs,  which  was  awarded  to  M.  HomoUe  and  M.  Quevenne 
for  the  discovery  of  digitaline  in  1846. 

The  work  thus  begun  has  been  continued  with  such  ac- 
tivity and  success  as  to  effectually  revolutionize  the  whole 
field  of  pharmacy  and  bedside  prescribing.  It  has  resulted 
in  relegating  nearly  all  crude  drugs  to  the  storehouses  or 
laboratories  of  the  wholesale  manufacturing  pharmacists, 
giving  to  the  physician  a  greater  variety  of  active  medicines 
in  a  simple  pocket  case  than  he  formerly  had  in  his  capa- 
cious and  w^ell-filled  saddle-bags,  and  presenting  for  the  pa- 
tient to  swallow  only  grains  or  minims,  and  those  often  en- 
cased in  tasteless  capsules,  instead  of  spoonful  doses  of  bit- 
ter powders  or  bowlfuls  of  still  more  bitter  infusions  or  de- 
coctions. 

In  direct  connection  with  the  separation  of  the  active 
constituents  of  crude  drugs,  came  investigations,  both  ex- 
perimental and  clinical,  by  which  the  actual  physiological  ac- 
tion of  such  constituents  on  the  living  system  was  deter- 
mined and  their  application  in  the  treatment  of  diseases  ren- 
dered more  exact  and  efficient.  The  important  discoveries 
concerning  the  functions  of  different  parts  of  the  brain  and 
nervous  system  opened  the  way  for  a  more  correct  knowl- 
edge of  insanity  and  mental  impairments,  and  thereby  im- 
proved that  department  of  medical  jurisprudence,  and  also 
led  to  a  better  understanding  of  the  nature  of  many  previous- 
ly obscure  nervous  affections,  as  may  be  seen  by  reference 
to  the  work  of  John  Abercrombie,  of  Edinburgh ;  the  Essay 
on  Shaking  Palsy,  by  James  Parkinson,  1817 ;  and  the  papers 
of  William  and  Daniel  Griffin,  of  Limerick,  on  Spinal  Irrita- 
tion, in  1834. 

Notwithstanding  the  great  activity  and  rapid  progress 
made  in  all  the  lines  of  original  research  to  which  allusion 
has  been  made,  there  were  no  attempts  to  create  new  sys- 
tems or  universal  theories  of  disease  during  the  first  half 
of  the  ninteenth  century.  The  three  leading  ones  of  the 
latter  part  of  the  previous  century,  i.  e.,  the  Cullenian,  the 
Brunonian  and  Broussaian,  culminated  in  their  influence 
before  the  end  of  the  first  quarter  of  the  nineteenth,  and 
began  to  decline.     As  they  were  all  based  on  the  exclusive 


127 

doctrine  of  solidism,  with  its  susceptibility  or  irritability 
and  stimuli,  and  making  the  first  step  in  disease  irritation, 
and  the  second  inflammation  with  fever,  their  foundation 
was  being  impaired  by  the  rapidly  accumulating  facts 
evolved  by  analytic  investigations  concerning  the  pathol- 
ogy of  the  blood  and  secretions  by  Andral,  Gavarret  and 
their  followers,  and  by  the  microscopic  demonstration  of 
living  organized  cells  in  the  blood  and  their  modification 
in  disease.  Though  the  Brunonian  system  was  sustained 
by  the  eminent  Benjamin  Rush,  of  Philadelphia,  and  by 
Samuel  Jackson  in  his  "Principles  of  Medicine",  and  by 
others  both  in  England  and  on  the  Continent  of  Europe, 
the  neurological  pathology  of  Cullen  maintained  its 
supremacy,  as  shown  by  the  Treatise  on  Fevers,  by  South- 
wood  Smith  in  England  and  by  the  systematic  works  on 
the  "Practice  of  Medicine"  by  John  Eberle,  in  1829,  and  by 
George  B.  Wood,  in  1847;  in  all  of  which  it  is  claimed  that 
the  first  link  in  the  chain  of  morbid  actions  constituting 
febrile  affections  is  an  irritative  or  morbid  impression  on 
the  nervous  system.  Practically,  however,  it  made  but  lit- 
tle difference  whether  attempts  were  made  to  trace  all 
morbid  actions  to  primary  impressions  on  the  nerves,  or 
on  the  inherent  irritability  of  all  the  tissues,  the  therapeutic 
inferences  led  to  the  adoption  of  the  general  antiphlogistic 
system  of  treatment  for  nearly  all  acute  diseases,  whether 
general  or  local.  The  system  consisted  essentially  in  rest, 
low  diet,  cooling  applications,  venesection  or  local  bleed- 
ing, cathartics,  and  sometimes  emetics,  in  the  first  stage, 
followed  by  sedative  diaphoretics  and  diuretics,  and  mer- 
curial alteratives,  and  in  the  later  stages  tonics  and  more 
nourishing  diet.  It  was  at  the  climax  of  its  popularity 
during  the  first  half  of  the  nineteenth  century,  and  like 
all  other  general  therapeutic  systems,  was  carried  to  un- 
reasonable extremes,  especially  in  blood-letting,  emeto- 
cathartics  and  mercurials,  by  a  small  proportion  of  prac- 
titioners. 

The  general  adoption  of  Jennerian  vaccination  at  the 
beginning  of  the  century  effectually  limited  the  destruc- 
tion of  human  life  by  sweeping  epidemics  of  small-pox ; 


128 

and  the  rebuilding  of  London  on  a  more  sanitary  basis 
after  its  destruction  by  fire  in  1666,  and  important  sani- 
tary improvements  in  and  around  Cairo  in  Egypt,  and 
most  of  the  great  cities  of  Europe,  equally  arrested  the 
further  destructive  prevalence  of  epidemics  of  the  plague 
in  Europe,  and  greatly  diminished  those  of  typhus  fever. 

The  most  noted  epidemic  diseases  of  the  first  half  of  the 
nineteenth  century  in  Europe  and  America  were  cholera,  in- 
fluenza, yellow  fever,  diphtheria,  erysipelas,  and  cerebro- 
spinal meningitis.  Erom  1817  to  1822  cholera  prevailed  se- 
verely in  India,  China  and  the  south  parts  of  Asia.  In 
■831  it  was  very  severe  and  fatal  throughout  Europe,  and 
in  1832  it  appeared  in  Canada  and  extended  rapidly  over  the 
United  States.  During  the  two  following  years  it  prevailed 
in  ]\Iexico  and  the  West  India  Islands.  In  1836-7  it  visited 
Central  America  and  again  s«.ourged  the  southern  part  of 
Europe.  It  then  disappeared  from  both  Europe  and  Amer- 
ica until  in  1848  it  revisited  almost  every  country  in  Europe, 
and  in  1849  ^t  was  equally  severe  in  America,  where  it  con- 
tinued to  recur  nearly  every  summer  until  1854.  Both  ery- 
sipelas and  cerebro-spinal  meningitis  have  been  epidemic 
in  limited  localities  in  many  countries.  But  their  most  noted 
and  extensive  prevalence  during  the  first  half  of  the  nine- 
teenth century  was  from  1841  to  1846,  when  they  extended 
over  the  greater  part  of  the  United  States  and  some  portions 
of  Europe.  Influenza,  in  its  true  epidemic  form,  swept  over 
the  greater  part  of  Asia,  Europe  and  America  in  1807; 
1831-3  and  in  1847,  attacking  a  greater  proportion  of  the 
whole  population  than  any  other  epidemic  of  modern  times, 
but  resulting  in  a  less  ratio  of  mortality. 

Diphtheria  prevailed  in  some  parts  of  Europe  from  1818 
to  1 82 1,  as  described  by  Bretonneau,  of  Tours,  and  to  a  lim- 
ited extent  in  this  country  in  1831,  as  described  by  Dr.  John 
Bell,  of  Philadelphia. 


129 


CHAPTER  X. 

HISTORY  OF  MEDICINE  DURING  THE  FIRST  HALF  OF  THE  NINE- 
TEENTH CENTURY  CONTINUED. 


The  Progress  of  Medical  Education;  the  Organization  of 
Medical  Societies,  Local,  State  and  National,  and  their 
Influence  on  the  Progress  of  Medical  Science  and  Practice. 


It  has  been  shown  in  the  preceding  chapters  that  not  un- 
til during  the  last  half  of  the  eighteenth  century  did  the  three 
primary  divisions  of  medical  practice  become  so  far  affiliated 
and  freed  from  the  dominating  influence  of  ecclesiastics, 
barbers  and  uneducated  midwives,  as  to  be  generally  rec- 
ognized as  one  profession.  Consequently  it  was  not  until 
the  period  just  named  that  the  medical  schools  in  various 
countries  began  to  make  adequate  provision  for  full  instruc- 
tion in  the  Practice  of  Medicine,  Surgery  and  Midwifery, 
as  well  as  in  Chemistry,  Anatomy,  Physiology  and  Materia 
Medica.  And  even  down  to  the  close  of  the  first  quarter 
of  the  nineteenth  century  in  a  large  majority  of  the  medical 
schools  active  instruction  was  given  only  half  or  three- 
quarters  of  the  calendar  year.  A  large  majority  of  students 
looked  for  the  larger  part  of  their  medical  knowledge  to 
the  books  and  instruction  of  private  preceptors  or  practition- 
ers, to  whom  many  were  indentured  legally,  the  same  as  in 
learning  the  mechanical  trades.  Many  resorted  to  the  med- 
ical schools  only  for  one  collegiate  year,  and  not  a  few 
attended  no  medical  college,  but  after  serving  the  al- 
lotted time  as  students,  they  entered  upon  the  general 
practice  of  medicine  with  no  other  credentials  than  the  cer- 
tificate of  their  preceptor.  Only  a  minority  of  those  en- 
gaging in  the  study  of  medicine  attended  regularly  some 
medical  school  three  or  more  years  and  graduated  either  as 
bachelors  or  doctors  of  medicine.  The  proportion  doing 
so  was  greater  on  the  continent  of  Europe.  In  Great  Britain 
perhaps  as  large  a  proportion  of  medical  students  attended 
medical  college  instruction  in  schools  connected  with  the 


130 

leading  hospitals  of  London,  and  with  the  universities  of 
Cambridge,  Edinburgh,  Glasgow  and  Dublin,  but  instead  of 
taking  college  or  university  degrees  they  were  very  gen- 
erally examined  and  licensed  by  one  of  the  royal  colleges  or- 
ganized for  that  purpose. 

In  the  United  States  of  America  at  the  beginning  of  the 
nineteenth  century  only  four  medical  colleges  were  in  ex- 
istence, i.  e.,  one  in  Philadelphia ;  one  in  New  York ;  one  in 
Boston ;  and  one  in  Hanover,  N.  H.  They  had  all  been  or- 
ganized as  ]\Iedical  Departments  of  Universities  or  general 
collegiate  institutions,  and  were  known  as  the  Medical 
Schools  of  Pennsylvania  University,  of  Columbia  College, 
N.  Y.,  of  Harvard  College,  j\Iass.,  and  Dartmouth  College, 
N.  H.  The  whole  country  was  comparatively  new,  it  hav- 
ing been  recognized  as  an  independent  people  among  the 
nations  of  the  earth  less  than  twenty-five  years.  Its  5,000,- 
000  of  inhabitants  were  sparsely  distributed  over  thirteen 
states  bordering  on  the  Atlantic  coast  extending  from  IMaine 
to  Florida,  with  neither  railroads  nor  even  good  wagon 
roads  to  facilitate  intercommunication  of  one  State  with 
another.  Consequently  at  the  opening  of  the  century  an 
aggregate  of  not  more  than  one  hundred  and  fifty  medical 
students  were  found  in  attendance  at  the  four  medical  schools 
then  existing,  and  not  more  than  thirty  or  forty  graduated, 
either  as  bachelors  or  doctors  of  medicine  in  any  one  year. 
Yet  it  would  not  be  correct  to  imply,  as  has  been  done  by 
some  writers,  that  the  country  was  then,  or  at  any  previous 
part  of  its  colonial  history,  destitute  of  fairly  well  educated 
physicians  and  surgeons.  For  some  such  very  generally 
came  with  the  immigrants  both  from  Great  Britain  and  the 
continent  of  Europe,  and,  as  explained  in  previous  chapters, 
not  a  few  young  men  resorted  to  the  University  of  Edin- 
burgh and  to  the  hospitals  and  schools  of  London  and  Paris. 

Another  source  of  valuable  medical  and  surgical  instruc- 
tion for  the  American  colonists  was  the  almost  constant 
wars  waged  by  Britain  and  France  with  each  other  and  with 
the  Indian  tribes  in  their  American  colonies ;  and  in  which 
the  inhabitants  of  the  colonies  were  compelled  to  take  part. 
In  doing  so  they  were  brought  in  frequent  contact  with  the 


131 

members  of  the  medical  and  surgical  staffs  of  the  English 
and  French  armies  operating  in  America. 

Neither  is  it  true  that  the  very  large  proportion  of  prac- 
titioners both  in  this  country  and  in  Europe,  who  depended 
for  their  medical  education  entirely  upon  the  books  and  in- 
struction of  their  preceptors  without  ever  entering  either  a 
medical  college  or  public  hospital,  were  entirely  destitute 
of  valuable  clinical  instruction,  as  has  been  often  stated.  On 
the  contrary  such  students  almost  from  the  beginning  be- 
came the  constant  assistants  of  their  preceptors  in  all  office 
work,  such  as  extracting  teeth,  venesection,  dressing  wounds, 
and  all  varieties  of  minor  surgical  operations ;  and  in  the 
last  half  of  their  pupillage  frequently  accompanied  their  pre- 
ceptors in  their  visits  to  important  cases,  or  went  as  sub- 
stitutes in  cases  of  emergency. 

From  all  the  preceding  circumstances  and  conditions  the 
impartial  investigator  will  find  that  through  all  the  last  half 
of  the  eighteenth  and  the  first  quarter  of  the  nineteenth  cen- 
turies there  was  but  little  difference  in  the  scientific  attain- 
ments, practical  skill,  and  general  professional  standing  of 
the  medical  profession  in  this  country  and  in  Europe.  It  is 
true  that  during  the  time  under  consideration  there  were  in 
all  the  countries  many  ignorant  or  only  partially  educated 
practitioners ;  many  charlatans  and  bombastic  pretenders,  as 
well  as  visionary  theorists  of  every  grade. 

And  is  it  not  equally  true,  that  now  in  the  early  years  of 
the  twentieth  century  of  the  christian  era,  all  these  evils  and 
evil  classes  still  exist  throughout  all  the  countries  more  or 
less?  For  there  is  scarcely  a  pathy  or  ism  or  theoretical 
dogma  of  the  seventeenth  and  eighteenth  centuries  that  does 
not  have  its  followers  among  us.  The  anti-vaccinationists, 
the  anti-vivisectionists,  the  Eddyites,  the  Dowieites,  the  Os- 
teopaths, and  those  wearing  the  trade-mark  of  him  who  in- 
vented the  two,  so-called,  universal  principles,  i.  e.,  "Similia 
Similibus  Curantur",  and  the  greater  the  attenuation  of  the 
dose  the  greater  the  curative  power,  still  flourish  on  both 
sides  of  the  Atlantic  Ocean. 

But  all  this  does  not  prove  that  true  medical  science  and 
art  have  not  been  progressing  with  increasing  rapidity  in 


132 

all  their  departments ;  for  there  is  no  garden  so  rich  that  it 
does  not  have  weeds,  and  no  forest  so  stately  that  it  does  not 
have  its  shrubs  and  parasites. 

No  sooner,  however,  had  the  several  departments  of  med- 
icine become  united,  and  the  medical  schools  prepared  to 
teach  the  whole,  than  an  increasing  disposition  was  mani- 
fested to  unite  in  forming  society  organizations  for  friendly 
intercourse  and  mutual  improvement.  Many  of  these  organ- 
izations embraced  not  only  the  branches  of  medicine  proper, 
but  also  many  of  the  collateral  sciences.  Before  the  begin- 
ning of  the  nineteenth  century  the  following  societies,  in 
which  medical  men  had  more  or  less  interest,  had  been  or- 
ganized in  Europe  and  America :  The  Royal  Colleges  of 
Physicians,  Surgeons  and  Apothecaries,  chiefly  for  the  reg- 
ulation of  medical  studies  and  the  examining  and  licensing 
of  candidates  for  permission  to  engage  in  the  practice  of 
medicine;  the  Royal  Society  of  London  for  the  promotion 
of  Science,  in  1662;  the  Academy  of  Sciences  in  France,  in 
1665 ;  the  German  Scientific  and  Medical  Association  at 
Schweinfurst  in  1652;  the  Medical  Society  of  New  Jersey 
organized  at  New  Brunswick,  in  1766;  the  Massachusetts 
State  Medical  Society,  in  1781 ;  the  Connecticut  State  Med- 
ical Society,  (1792)  and  the  New  Hampshire  Medical  So- 
ciety, in  1791 ;  the  Philadelphia  College  of  Physicians,  in 
1787;  and  the  Philadelphia  Medical  Society,  in  1789. 

The  several  societies  enumerated  were  sanctioned  by  acts 
of  incorporation  by  the  legislative  bodies  of  the  several  coun- 
tries or  states  in  which  they  were  located.  Their  avowed 
objects  were  the  promotion  of  friendly  intercourse,  the  ad- 
vancement of  medical  science,  and  the  support  of  the  useful- 
ness and  honor  of  the  medical  profession.  Nearly  all  of 
them  are  still  in  existence,  and  have  proved  true  to  the  ob- 
jects of  their  organization. 

Perhaps  the  first  of  the  society  organizations  in  America 
to  commence  the  publication  of  a  separate  volume  of  transac- 
tions was  that  of  Massachusetts  prior  to  1800.  It  contained 
papers  by  ten  of  its  members,  the  most  important  of  which 
were :  "An  account  of  the  weather  and  epidemics  of  Salem, 
County  of  Essex,  for  the  year  1786,  with  a  bill  of  mortality 


133 

for  the  same  year,"  by  Edward  A.  Holyoke,  M.  D. ;  "A  case 
of  Empyema  successfully  treated  by  an  operation"  by  Dr. 
Isaac  Rand,  in  1783;  "Observations  on  Hydrocephalus  In- 
temus  by  operation"  by  Dr.  Isaac  Rand,  Jr.,  in  1789;  and 
"An  account  of  an  aneurism  of  the  thigh  cured  by  an  op- 
eration and  the  use  of  the  limb  preserved"  by  Thomas  Kast, 
M.  D.,  in  1790.  Another  volume  was  not  published  by  the 
same  society  until  1808. 

In  Great  Britain  the  British  Royal  Society  has  regularly 
published  its  "Philosophical  Transactions"  since  1665. 

The  Royal  Medical  Society  of  Edinburgh  was  founded 
in  1737,  and  the  Medical  Society  of  London  in  1773. 

During  the  eighteenth  century  many  so-called  learned 
societies  were  organized  in  France,  Germany,  Switzerland 
and  Italy,  chiefly  devoted  to  the  consideration  of  strictly 
scientific  and  philosophical  subjects,  but  in  the  membership 
of  which  were  embraced  many  physicians.  Perhaps  the  most 
famous  of  these  societies  was  the  "Konigliche  Academie" 
formed  by  the  union  of  two  preceding  societies  by  Fred- 
erick the  Great  in  1744  at  Berlin;  and  the  Konigliche  Gesell- 
schaft  der  Wissenschaften  zu  Gottingen  founded  by  the  in- 
fluence of  Haller  in  1751. 

In  France  there  were  Societes  Royales  des  Sciences  of 
Montpellier  in  1706,  of  Bordeaux  in  1714,  of  Lyons  in  1724, 
and  Dijon  in  1725. 

In  Switzerland,  the  "Gesellschaft  der  Artze  und  Natur- 
forscher"  of  Basil  in  1751,  and  the  "Naturforschende 
Gesellschaft"  of  Zurich,  1757,  exerted  much  influence,  as 
did  also  the  Imperial  Russian  Society  of  St.  Petersburg, 
1724;  the  Royal  Swedish  Academy  of  Stockholm,  1739;  and 
the  Royal  Danish  Society  at  Copenhagen. 

The  formation  of  medical  and  scientific  societies  by  which 
members  of  the  profession  were  frequently  brought  together 
for  the  reading  of  papers,  and  for  the  discussion  of  questions 
pertaining  to  both  the  science  and  practice  of  medicine,  has 
proved  to  be  one  of  the  most  efficient  agencies  for  the  de- 
velopment and  diffusion  of  medical  knowledge  that  we  pos- 
sess. 

Coincident  with  the  formation  of  scientific  and  medical 


134 

societies  and  the  publication  of  their  transactions,  came  also 
the  printing  of  newspapers,  magazines,  and  periodicals.  The 
first  were  generally  published  weekly  and  were  devoted  to 
politics  and  miscellaneous  news  items ;  the  second  were  more 
generally  published  monthly  and  devoted  to  literature  and 
art ;  the  third  were  published  monthly  or  quarterly  and  were 
more  generally  devoted  to  some  departments  of  science  or 
medicine.  The  first  weekly  newspaper  of  which  we  have 
any  record  was  the  London  Weekly  News,  first  issued  May 
23rd,  1622,  and  edited  by  Nathaniel  Butters  and  Nicholas 
Bourne.  The  next  one  to  appear  was  "The  Gazette  de 
France",  May  30th,  1631.  One  of  the  early  and  most  impor- 
tant journals  devoted  to  both  medicine  and  scientific  topics 
generally  was  called  "Der  Arzt",  issued  in  1759,  and  was 
continued  twelve  years  under  the  management  of  Joh.  Aug. 
Unzer,  an  eminent  physiologist  and  practising  physician  at 
Hamburg. 

A  Journal  devoted  to  Military  Medicine  and  Surgery 
was  published  in  Paris,  from  1782  to  1788.  Some  trawsla- 
tions  from  this  were  published  in  New  York  in  1790.  The 
first  original  medical  journal,  however,  published  in  America 
was  The  Medical  Repository,  commenced  in  1797  at  New 
York,  and  issued  quarterly  until  1824.  It  was  ably  edited 
by  Drs.  Elihu  H.  Smith,  Edward  Miller,  and  Samuel  L. 
Mitchell. 

No  other  medical  periodical  appeared  in  this  country 
until  September,  1804,  when  the  Philadelphia  Medical  Mu- 
seum made  its  appearance,  edited  by  Dr.  John  Redman 
Coxe,  followed  one  month  later  by  the  Philadelphia  Med- 
ical and  Physical  Journal,  edited  by  Dr.  Benj.  Smith  Barton. 

These  several  journals,  together  with  those  established 
in  Europe  during  the  last  half  of  the  eighteenth  century, 
called  forth  much  talent  hitherto  dormant,  by  eliciting  es- 
says and  papers  from  many  of  the  more  intelligent  members 
of  the  profession. in  the  several  countries;  by  publishing  the 
proceedings  of  the  medical  societies ;  and  by  affording  a 
free  channel  for  dignified  scientific  discussions.  Thereby 
they  became  efficient  auxiliaries  to  the  medical  colleges  and 


'00 


societies  in  the  great  work  of  medical  education  and  ad- 
vancement. 

With  the  organization  of  medical  societies  and  the  fair 
inauguration  of  a  medical  periodical  press,  there  came  more 
general  discussions  concerning  the  necessity  for  appropriate 
and  just  laws  regarding  the  qualifications  of  physicians  and 
the  preservation  of  the  public  health. 

The  few  and  very  limited  attempts  to  establish  some 
standard  of  qualifications  for  .those  who  should  be  permit- 
ted to  engage  in  the  practice  of  medicine  and  surgery,  made 
during  the  Grecian,  Roman  and  Arabian  periods  of  medical 
history,  have  been  noticed  in  preceding  chapters.  But  not 
until  the  permanent  establishment  of  the  Royal  College  of 
Physicians  and  Surgeons  in  Great  Britain  during  the  eight- 
eenth century,  and  the  more  stable  condition  of  the  leading 
Universities  on  the  continent  of  Europe,  did  these  several 
institutions  become  invested  with  authority  to  examine  all 
parties  desiring  to  commence  the  study  of  medicine,  and  to 
grant  permission  to  such  only  as  possessed  an  academic  or 
good  general  education,  including  the  natural  sciences  and 
the  Latin  language.  The  same  institutions  were  also  in- 
vested with  authority  to  adopt  a  curriculum  of  medical 
studies,  generally  extending  over  a  period  of  four  or  five 
years,  with  annual  examinations  in  progress,  and  the  final 
granting  of  licenses  or  degrees  to  such  as  completed  the 
course  satisfactorily.  And  none  but  those  who  received 
such  licenses  or  degrees  were  legally  authorized  to  practise 
medicine  and  surgery  in  the  countries  in  which  the  licensing 
institutions  were  located. 

In  the  American  colonies,  prior  to  their  declaration  of 
independence  of  Great  Britain  in  1776,  but  few  laws  were 
enacted  having  for  their  object  the  regulation  of  medical  ed- 
ucation and  practice.  The  earliest  of  such  laws  of  which  we 
have  any  record  related  to  the  practice  of  midwifery,  which 
was  almost  exclusively  in  the  hands  of  uneducated  mid- 
'  wives.  In  July,  1716,  the  legal  authorities  of  New  York 
City  adopted  and  proclaimed  an  ordinance  as  follows :  'Tt 
is  ordained  that  no  woman  within  this  corporation  shall  ex- 
ercise the  employment  of  midwife  until  she  have  taken  oath 


136 

before  the  mayor,  recorder  or  an  alderman  to  the  following 
effect:  That  she  will  be  diligent  and  ready  to  help  any 
woman  in  labor,  whether  poor  or  rich ;  that  in  time  of  ne- 
cessity she  will  not  forsake  the  poor  woman  and  go  to  the 
rich ;  that  she  will  not  cause  or  suffer  any  woman  to  name 
or  put  any  other  father  to  the  child,  but  only  him  which  is 
the  true  father  thereof,  indeed,  according  to  the  utmost  of 
her  power;  that  she  will  not  suffer  any  woman  to  pretend 
to  be  delivered  of  a  child  who  is  not,  indeed,  neither  to  claim 
any  other  woman's  child  as  her  own ;  that  she  will  not  suffer 
any  woman's  child  to  be  murdered  or  hurt ;  and  as  often  as 
she  shall  see  any  peril  or  jeopardy,  either  in  the  mother  or 
child,  she  will  call  in  other  midwives  for  council ;  that  she 
will  not  administer  any  medicine  to  produce  miscarriage; 
that  she  will  not  enforce  a  woman  to  give  more  for  services 
than  is  right ;  that  she  will  not  collude  to  keep  secret  the  birth 
of  a  child;  will  be  of  good  behavior;  and  will  not  conceal 
the  birth  of  bastards."    (Baas.) 

Such  an  ordinance  sufficiently  indicates  the  condition  of 
midwifery  practice  in  the  early  part  of  the  eighteenth  cen- 
tury. 

So  far  as  is  known,  the  first  male  physicians  known  to 
have  engaged  in  the  practice  of  obstetrics  in  this  country 
were  Dr.  John  Moultrie,  a  Scotchman,  who  settled  in 
Charleston,  S.  C,  in  1733;  Dr.  John  Dupuy,  of  New  York, 
whose  death  was  announced  with  regret  in  the  N.  Y.  Weekly 
Post  Boy,  July  22nd,  1745 ;  and  Dr.  James  Lloyd,  a  pupil  of 
William  Hunter  and  Smellie,  who  commenced  practice  in 
Boston  in  1752.  And  as  has  been  stated  in  a  previous  chap- 
ter, Dr.  William  Shippen,  Jr.,  of  Philadelphia,  was  the  first 
to  give  a  course  of  lectures  on  Obstetrics,  and  Dr.  John  V. 
B.  Tennant,  of  New  York,  the  first  to  receive  the  appoint- 
ment of  full  professor  of  midwifery,  which  was  in  the  Med- 
ical Department  of  Kings  College,  N.  Y.,  in  1767. 

The  first  law  for  regulating  the  practice  of  medicine  and 
surger\'  was  enacted  by  the  General  Assembly  of  New  York 
in  1760,  as  follows :  "No  person  whatsoever  shall  practise 
as  physician  or  surgeon  in  the  City  of  New  York  before  he 
shall  have  been  examined  in  physic  and  surgery,  and  ap- 


137 

proved  of  and  admitted  by  one  of  his  Majesty's  Council, 
the  Judges  of  the  Supreme  Court,  the  King's  Attorney  Gen- 
eral, and  the  Mayor  of  the  City  of  New  York  for  the  time 
being,  or  by  any  three  or  more  of  them,  taking  to  their  as- 
sistance for  such  examination  such  proper  person  or  per- 
sons, as  they  in  their  discretion  shall  see  fit."  A  penalty  of 
five  pounds  was  prescribed  for  all  violations  of  the  law ;  but 
its  operation  was  limited  to  the  City  of  New  York.  In  1772 
a  similar  law  was  enacted  by  the  Colony  of  New  Jersey. 

The  law  of  1760  in  New  York  remained  substantially 
the  same  until  it  was  superseded  by  an  Act  of  Legislature  of 
that  State  passed  in  1797,  which  prohibited  all  persons  from 
practising  physic  or  surger}^  in  that  state  without  a  license 
from  one  or  more  of  the  officers  named  in  the  law  of  1760, 
under  a  penalty  of  $25  for  each  offense.  The  period  re- 
quired for  medical  study  was  made  four  years,  with  a  de- 
duction of  one  year  in  favor  of  those  who  had  graduated  at 
a  literary  college.  Each  candidate  was  also  required  to  fur- 
nish the  examining  officers  with  a  certificate  of  the  time  he 
had  studied,  verified  by  the  oath  of  his  preceptor;  and  his 
license  was  to  be  filed  in  the  office  of  the  Clerk  of  the  County 
in  which  he  commenced  practice.  Students  who  had  re- 
ceived the  degree  of  bachelor  or  doctor  of  medicine  from 
a  medical  college  were  permitted  to  practise  on  filing  a  copy 
of  their  diploma  without  further  examination. 

The  medical  society  that  had  existed  in  New  Jersey  since 
1766  was  incorporated  by  an  Act  of  the  Legislature  of  that 
State  in  1790,  under  the  name  of  the  Medical  Society  of  the 
State  of  New  Jersey.  By  the  Act  of  incorporation  that 
State  Society  was  authorized  to  appoint  censors  to  examine 
and  license  candidates  for  permission  to  practise  medicine 
in  that  state.  The  terms  of  study  required,  and  all  the  reg- 
ulations adopted,  were  much  the  same  as  those  prescribed 
in  the  New  York  law  of  1797.  The  New  Jersey  law  also 
authorized  the  formation  of  district  or  county  societies  whose 
delegates  were  to  constitute  the  State  Society. 

The  Medical  Society  of  the  State  of  South  Carolina  was 
incorporated  by  the  Legislature  in  1797,  but  no  provision 
was  made  for  examining  persons  for  license  to  practise. 


138 

In  1/99  ^^  "Medical  Chirurgical  Faculty  of  the  State 
of  Maryland"  was  incorporated  by  the  State  Legislature, 
and  given  power  to  elect  by  ballot  twelve  persons  of  the 
greatest  medical  and  chirurgical  abilities  in  the  State,"  who 
shall  be  styled  the  ]\Iedical  Board  of  Examiners  for  the 
State  of  Maryland."  It  was  made  the  duty  of  said  Board 
"to  grant  licenses  to  such  medical  and  chirurgical  gentlemen 
as  they  either  by  examination  or  upon  the  production  of  di- 
plomas from  some  respectable  medical  college,  may  judge 
adequate  to  commence  the  practice  of  the  medical  and  chirur- 
gical arts."  By  a  supplementary  act  of  the  legislature  passed 
in  1801,  the  State  Board  of  Examiners  required  all  persons 
proposing  to  practise  in  the  State,  whether  graduates  of 
medical  colleges  or  not,  to  appply  for  a  license  before  com- 
mencing practice;  and  all  who  were  licensed  by  the  Board 
were  by  virtue  of  such  license  made  members  of  the  State 
Society.  A  penalty  of  fifty  dollars  was  imposed  for  each 
violation  of  the  foregoing  provisions,  to  be  collected  in  the 
County  Court  where  the  offender  might  reside. 

It  is  thus  seen  that  Maryland  was  not  only  one  of  the 
earlier  states  to  enact  laws  for  the  protection  of  her  citizens 
against  the  inroads  of  ignorance  and  empiricism,  but  also 
that  her  laws  relating  to  the  subject  were  the  most  simple 
and  effectual. 

By  the  foregoing  details  it  appears  that  six  of  the  orig- 
inal thirteen  states  had  recognized  their  right  and  duty  to 
legislate  on  the  subjects  of  medical  education  and  practice 
during  the  first  twenty  years  after  the  achievement  of  their 
independence.  The  union  of  all  legitimate  branches  of  med- 
ical science  and  practice  in  one  profession  with  fairly  well 
established  medical  schools ;  the  organization  of  medical  so- 
cieties for  mutual  improvement  arid  the  free  discussion  of 
all  medical  subjects ;  and  the  initial  development  of  a  med- 
ical periodical  press,  were  the  important  agencies  that  at  the 
beginning  of  the  nineteenth  century  greatly  increased  the 
rapidity  of  progress  in  all  that  relates  to  the  advancement 
of  medicine  and  its  application  to  the  various  interests  of  hu- 
man society.  These  several  agencies  having  acquired  only 
an  initial  beginning  with  the  commencement  of  the  nine- 


139 

teenth  century,  have  since  increased  in  extent  and  influence 
with  a  rapidity  difficult  to  appreciate.  On  the  9th  of  April, 
1806,  the  Legislature  of  the  State  of  New  York  passed  a  law 
authorizing  "the  legally  qualified  physicians  and  surgeons 
of  each  county  to  form  themselves  into  a  society,  named  after 
the  county  in  which  it  was  formed,  with  power  to  choose 
officers,  make  all  needful  rules  for  the  government  of  its 
members,  and  appoint  a  board  of  censors  to  examine  and 
license  all  the  applicants  for  admission  into  the  profession 
in  their  respective  counties.  But  no  one  could  be  admitted 
to  an  examination  until  he  had  given  evidence  of  having 
studied  three  years  with  some  practitioner,  and  had  arrived 
to  the  age  of  twenty-one  years."  (See  History  of  Medical 
Education,  etc.,  by  N.  S.  Davis,  1851).  The  law  also  pro- 
vided for  the  formation  of  a  State  Medical  Society,  com- 
posed of  delegates  from  each  County  Society,  and  permanent 
members  not  exceeding  two  each  year  chosen  by  the  society 
in  annual  session  in  Albany. 

The  State  Society  was  required  to  divide  the  State  into 
four  medical  districts,  and  appoint  a  board  of  censors  in 
each,  whose  duty  was  to  examine  all  applicants  for  license  to 
practise  medicine  and  surgery  after  having  studied  at  least 
three  years.  The  law  forbids  any  one  to  enter  the  medical 
profession  or  to  practise  medicine  or  surgery  without  first 
having  procured  a  license  from  a  County  or  State  Society 
or  a  diploma  from  an  organized  medical  college.  County 
Societies  were  quickly  organized  in  nearly  every  county  in 
the  State ;  and  the  State  Society  held  its  first  meeting  at  the 
capital  in  Albany  in  February,  1807,  when  its  organization 
was  completed. 

Two  very  important  objects  were  accomplished  by  the 
foregoing  law,  i.  e.,  a  thorough  organization  of  the  pro- 
fession throughout  the  State  in  a  manner  most  favorable  for 
its  advancement;  and  the  examination  of  all  candidates  for 
admission  by  practitioners  of  medicine  without  the  interven- 
tion of  any  other  class.  The  enactment  of  the  law  in  New 
York  was  largely  owing  to  the  influence  of  Dr.  John  Stearns, 
of  Saratoga  County,  Dr.  Alexander  Sheldon,  of  Montgom- 
ery County,  and  Hon.  Wm.  W.  Van  Ness,  all  of  whom  were 


140 

members  of  the  Legislature  at  the  time.  Important  amend- 
ments to  the  law  were  enacted  in  1818  and  in  1827,  by  which 
the  term  of  medical  study  was  extended  to  four  years  with 
the  privilege  of  deducting  one  year  in  behalf  of  such  stu- 
dents as  had  pursued  classical  studies  one  year  after  the  age 
of  sixteen  years,  or  had  attended  one  full  annual  course  of 
medical  college  instruction.  And  no  person  was  permitted 
to  receive  the  degree  of  doctor  of  medicine  from  the  Regents 
of  the  University  of  the  State,  unless  he  had  studied  medi- 
cine at  least  three  years  with  some  respectable  practitioner, 
and  had  attended  two  full  annual  courses  of  medical  college 
instruction  in  an  incorporated  medical  college. 

The  example  of  New  York  was  followed  by  the  Legisla- 
tures of  other  states  until  prior  to  1850  nearly  every  state 
in  the  Union  had  laws  providing  for  City,  County,  District 
and  State  Medical  Societies,  and  more  or  less  for  the  protec- 
tion of  the  people  from  the  effects  of  imposition  and  igno- 
rance on  the  part  of  those  attempting  to  practise  medicine. 
Though  the  laws  of  the  several  states  were  very  defective  in 
regard  to  protection  of  the  people  against  ignorant  and  il- 
legal practice,  yet  the  frequent  contact  of  members  of  the 
profession  with  each  other  in  the  County  and  State  Societies 
where  they  were  occupied  in  the  reading  of  papers,  the  re- 
lation of  cases,  and  the  discussion  of  topics  connected  with 
the  prevalence  and  treatment  of  diseases  in  their  own  locali- 
ties, soon  led  them  to  a  more  thorough  knowledge  of  each 
other,  and  the  adoption  of  by-laws  and  correct  ethical  rules 
for  their  mutual  government  and  private  intercourse.  Many 
of  the  papers  and  public  addresses  found  their  way  into  the 
m.edical  periodicals  or  into  the  annual  volumes  of  transac- 
tions of  the  State  Societies. 

Probably  the  most  important  medical  society  organiza- 
tion effected  in  Eyrope  during  the  first  half  of  the  nineteenth 
century,  was  the  "Provincial  ^vledical  and  Surgical  Associa- 
tion", organized  at  Worcester,  England,  July,  1832.  It  was 
effected  by  an  assembly  of  about  fifty  medical  men  from 
leading  provincial  towns  in  the  south  part  of  England  under 
the  able  leadership  of  Dr.  Charles  Hastings,  of  Worcester. 
The  avowed  objects  of  the  Association  were  the  cultivation 


141 

of  friendly  intercourse,  mutual  improvement  and  the  ad- 
vancement of  medical  science.  At  its  second  meeting,  1833, 
its  membership  numbered  one  hundred  and  forty.  Its  meet- 
ings were  held  annually  in  some  one  of  the  provincial  towns, 
and  were  attended  by  a  steadily  increasing  membership,  giv- 
ing rise  to  the  publication  of  an  annual  volume  of  transac- 
tions containing  many  papers  that  attracted  wide  attention. 

It  was  to  the  annual  meeting  of  this  Association  in  1842 
that  Justus  Liebig  presented  his  celebrated  paper  on  "Or- 
ganic Chemistry  in  its  relations  to  Physiology  and  Patholo- 
gy", described  in  a  preceding  chapter.  Under  the  judicious 
leadership  of  Dr.  Hastings  (afterwards  Sir  Charles  Hast- 
ings) the  Association  continued  to  prosper  until  1856,  when 
its  plan  of  organization  was  extended  by  provision  for  the 
organization  of  branches  in  all  parts  of  the  Kingdom,  en- 
titled to  representation  in  the  annual  meetings,  and  its  name 
was  changed  to  that  of  British  Medical  Association.  It  was 
thus  changed  from  a  strictly  provincial  to  a  national  organ- 
ization, and  has  since  become  one  of  the  largest  and  most 
influential  medical  associations  in  the  world. 

By  the  union  of  the  several  American  states  under  a 
written  constitution,  making  them  one  nation,  all  matters 
pertaining  to  education  were  left  to  the  regulation  of  the  in- 
dividual states.  Consequently  while  the  Legislatures  of  the 
several  states  granted  acts  of  incorporation  to  County  and 
State  Medical  Societies  with  power  to  appoint  censors  to 
examine  candidates  for  permission  to  practise  medicine,  as 
has  been  previously  stated,  they  also  granted  charters  for 
new  medical  colleges  as  often  as  they  were  requested  by  am- 
bitious members  of  the  profession.  Such  charters  usually 
placed  no  restrictions  upon  the  colleges,  except  the  require- 
ment of  three  years  of  medical  study  and  attendance  upon 
two  annual  terms  of  college  instruction  before  graduation  as 
doctors  of  medicine. 

Each  medical  college  was  permitted  to  regulate  its  own 
curriculum  of  studies,  the  length  of  its  annual  courses  of  in- 
struction, and  its  fees.  Nearly  all  of  them  were  without  pe- 
cuniary endowments  and  consequently  dependent  upon  the 
fees  of  students  for  their  support.    This  led  rapidly  to  an 


142 

active  competition  for  students  not  based  on  an  effort  to  see 
which  colleges  should  give  the  most  full  and  systematic 
courses  of  instruction,  but  rather  which  could  confer  the 
degree  of  doctor  of  medicine  at  the  least  cost  to  the  students 
in  time  and  money. 

The  college  degree  of  M.  D.,  being  almost  everywhere 
accepted  as  authority  to  practise  without  other  examina- 
tions, the  college  that  offered  to  confer  it  after  attendance 
on  the  shortest  annual  courses  of  instruction  and  the  lowest 
college  fees  could  generally  draw  the  largest  class. 

Under  these  conditions  and  tendencies  the  annual  courses 
of  medical  college  instruction  were  progressively  shortened 
from  six  months  as  required  by  the  first  colleges  in  Phila- 
delphia and  New  York,  prior  to  1800,  to  sixteen  weeks  or 
less ;  all  semblance  of  a  requirement  of  suitable  prelim- 
inary education  was  omitted ;  and  before  the  middle  of  the 
century  had  been  reached  the  number  of  medical  colleges 
had  increased  from  four  to  forty,  and  the  annual  aggregate 
number  of  medical  graduates  from  fifteen  to  more  than  one 
thousand.  By  nominally  studying  medicine  three  years,  in- 
cluding two  annual  repetitional  courses  of  medical  college 
instruction  of  less  than  four  months  each,  the  student  could 
obtain  a  diploma  entitling  him  to  practise,  which  was  easier 
and  more  economical  than  to  study  with  a  preceptor  four 
years  and  pass  an  examination  by  the  censors  of  a  County 
or  State  Society. 

The  foregoing  conditions  concerning  medical  education 
and  institutions  in  the  United  States  during  the  first  half 
of  the  nineteenth  century  were  severely  criticised  by  leading 
members  of  the  profession  both  in  medical  societies  and  in 
the  medical  periodicals.  At  the  annual  meeting  of  the  New 
York  State  Medical  Society  in  February,  1844,  I,  then  a 
young  delegate  from  the  Broome  County  Medical  Society, 
presented  a  series  of  resolutions  "declaring  in  favor  of  the 
adoption  of  a  fair  standard  of  general  education  for  stu- 
dents before  commencing  the  study  of  medicine ;  of  length- 
ening the  annual  courses  of  medical  college  instruction  to  at 
least  six  months  with  the  grading  of  the  curriculum  of 
studies ;  and  of  having  all  examinations  for  license  to  prac- 


143 

tise  medicine  conducted  by  State  Boards,  independent  of  the 
colleges."  After  a  brief  discussion  the  resolutions  were 
laid  on  the  table  until  the  next  annual  meeting  of  the  so- 
ciety, and  copies  of  them  ordered  sent  to  the  several  County 
Medical  Societies  in  that  State,  and  to  the  medical  period- 
icals. At  the  next  annual  meeting,  1845,  the  resolutions 
were  taken  from  the  table  and  during  a  free  discussion  it 
was  urged  with  much  force  that  the  requirements  of  a  fair 
standard  of  education  before  commencing  medical  studies, 
a  longer  annual  college  term  with  proper  grading  of  the 
curriculum,  and  independent  examinations  for  license  to 
practise  in  New  York  State  alone,  would  only  cause  the  stu- 
dents to  abandon  her  colleges  for  those  of  Pennsylvania  or 
the  New  England  states. 

This  caused  the  original  mover  of  the  resolutions  to 
offer  the  following  preamble  and  resolutions : 

"Whereas,  it  is  believed  that  a  National  Convention 
would  be  conducive  to  the  elevation  of  the  standard  of  med- 
ical education  in  the  United  States,  and 

"Whereas,  there  is  no  mode  of  accomplishing  so  desirable 
an  object  without  concert  of  action  on  the  part  of  the  med- 
ical societies,  colleges^  and  institutions  of  all  the  states,  there- 
fore 

"Resolved,  That  the  New  York  State  Medical  Society 
earnestly  recommends  a  National  Convention  of  delegates 
from  medical  societies  and  colleges  in  the  whole  Union,  to 
convene  in  the  City  of  New  York  on  the  first  Tuesday  in 
May,  1846,  for  the  purpose  of  adopting  some  concerted  ac- 
tion on  the  subject  set  forth  in  the  foregoing  preamble. 

"Resolved,  That  a  committee  of  three  be  appointed  to 
carry  the  foregoing  resolution  into  effect." 

The  preamble  and  resolutions  were  adopted  and  the 
committee  appointed  with  the  mover  for  chairman.  By  dili- 
gent correspondence  and  discussions  in  the  medical  press, 
before  the  time  for  which  the  convention  had  been  called  ar- 
rived, a  convention  of  delegates  representing  a  large  major- 
ity of  the  medical  societies  and  colleges  of  all  the  States  of 
the  Union  assembled  in  New  York,  May  5th,  1846.     The 


144 

duly  accredited  delegates  in  attendance  numbered  about  one 
hundred. 

Dr.  Jonathan  Knight,  of  New  Haven,  Ct.,  was  elected 
President  and  Dr.  Richard  D.  Arnold,  of  Savannah,  Ga., 
and  Dr.  Alfred  Stille,  of  Philadelphia,  Pa.,  Secretaries.  The 
six  following  propositions  were  fairly  discussed  and  adopted 
during  the  two  days  the  convention  remained  in  session, 
viz. : 

1.  That  it  is  expedient  for  the  medical  profession  of 
the  United  States  to  institute  a  National  Medical  Association. 

2.  That  it  is  desirable  that  a  uniform  and  elevated  stand- 
ard of  requirements  for  the  degree  of  AI.  D.  should  be  adopt- 
ed by  all  the  medical  schools  in  the  United  States. 

3.  That  it  is  desirable  that  young  men,  before  being  re- 
ceived as  students  of  medicine,  should  have  acquired  a  suit- 
able preliminary  education. 

4.  That  it  is  expedient  that  the  medical  profession  of 
the  United  States  should  be  governed  by  the  same  code  of 
Medical  Ethics. 

5.  That  all  licenses  to  practise  medicine  should  be  conr 
ferred  by  a  single  Board  of  Medical  Examiners  in  each  State. 

6.  That  suitable  laws  should  be  enacted  in  each  State 
for  the  registration  of  births,  marriages  and  deaths,  and  the 
adoption  of  a  nomenclature  of  diseases. 


145 


CHAPTER  XL 

THE  PROGRESS  AND  INFLUENCE  OF  MEDICAL  SOCIETY  ORGAN- 
IZATIONS continued;  their  influence  on  the  PROG- 
RESS OF  medical  education,  AND  ON  THE  SUBSTITUTION 
OF  DIRECT  CLINICAL  AND  EXPERIMENTAL  INVESTIGATIONS 
IN  ALL  DEPARTMENTS  OF  MEDICINE,  INSTEAD  OF  THEORIZ- 
ING AND  MEDICAL  SYSTEM  BUILDING,  DURING  THE  LAST 
HALF  OF  THE  NINETEENTH  CENTURY. 

In  the  closing  part  of  the  preceding  chapter  attention 
was  directed  to  the  origin  and  formation  of  the  American 
Medical  Association  which  was  completed  in  May,  1847, 
at  Philadelphia,  by  a  convention  of  representatives  from  a 
large  majority  of  the  permanently  organized  Medical  So- 
cieties, Medical  Colleges,  Hospitals  and  Asylums  then  exist- 
ing in  the  United  States  of  America.  It  was  organized  as 
a  strictly  representative  body,  admitting  one  delegate  for 
every  ten  resident  members  of  the  State,  County  and  District 
Medical  Societies,  two  delegates  from  each  regular  Medical 
College,  two  from  the  Medical  Corps  of  the  Army  and  the 
Navy,  and  one  from  the  Medical  Staff  of  each  permanent 
Hospital  and  Asylum  in  the  several  States.  It  was  therefore 
a  truly  representative  national  organization  of  the  profes- 
sion, and  the  first  of  its  kind  in  any  country.  The  Pro- 
vincial Medical  and  Surgical  Association,  which  was  or- 
ganized at  Worcester,  England,  in  July,  1832,  as  stated  in 
the  preceding  chapter,  was  not  reorganized  on  a  national 
basis  under  the  name  of  British  Medical  Association  until 
1856.  The  important  purposes  for  which  the  American 
Medical  Association  was  organized  were  declared  to  be  "for 
cultivating  and  advancing  medical  knowledge ;  for  elevating 
the  standard  of  medical  education ;  for  promoting  the  use- 
fulness, honor  and  interests  of  the  medical  profession ;  for 
enlightening  and  directing  public  opinion  in  regard  to  the 
duties,  responsibilities  and  requirements  of  medical  men; 
for  exciting  and  encouraging  emulation  and  concert  of  ac- 


146 

tion  in  the  profession;  and  for  facilitating  and  fostering 
friendly  intercourse  between  those  engaged  in  it." 

The  first  President  of  the  Association  was  Dr.  Nathaniel 
Chapman,  of  Philadelphia,  Professor  of  Practical  Medicine 
in  the  Medical  Department  of  the  Pennsylvania  University. 

The  Constitution,  By-laws,  Code  of  Ethics  and  Nomen- 
clature of  Diseases  devised  by  the  Convention  were  adopted 
by  the  Association,  and  in  accordance  therewith  standing 
committees  were  appointed  to  consider  and  report  at  the  next 
annual  meeting  on  Medical  Sciences ;  Practical  Medicine ; 
Surgery;  Obstetrics;  ]\Iedical  Education;  and  on  Medical 
Literature. 

The  next  meeting  was  held  in  Baltimore,  May,  1848, 
and  able  reports  were  made  by  all  the  standing  committees, 
which,  after  discussion,  were  referred  for  publication  in 
the  annual  volume  of  transactions  of  the  Association.  The 
report  on  medical  education  elicited  much  discussion  and 
ended  in  the  adoption  of  resolutions  earnestly  recommend- 
ing a  fair  standard  of  academic  or  general  education  before 
commencing  to  study  medicine ;  longer  annual  courses  of 
medical  college  instruction,  and  a  systematic  grading  of  the 
curriculum  of  medical  studies. 

The  reports  on  medical  sciences  and  on  practical  medi- 
cine also  turned  much  attention  to  the  investigation  of  epi- 
demic diseases  and  to  sanitary  measures  for  their  preven- 
tion. 

The  Association  continued  to  hold  its  annual  meetings 
successively  in  the  larger  cities  of  the  different  sections  of 
the  country  with  entire  regularity,  except  the  two  first  years 
of  the  civil  war,  1861  and  1862,  resulting  in  infusing  new 
life  and  activity  into  all  the  state  and  local  medical  so- 
cieties already  existing,  and  promoting  the  organization  of 
new  societies  in  states  and  counties  where  none  had  ex- 
isted before.  The  increased  attention  given  to  the  subject 
of  aetiology  and  preventive  medicine  in  a  few  years  led  to  the 
organization  of  the  American  Public  Health  Association, 
and  to  the  formation  of  a  National  Association  of  the  Med- 
ical Superintendents  of  Asylums  for  the  Insane. 

The  persistent  demand  for  a  higher  standard  of  medical 


147 

education  and  a  more  systematic  arrangement  of  studies  in 
the  medical  schools,  at  each  annual  rheeting  of  the  American 
Medical  Association,  finally  resulted  in  the  holding  of  a 
convention  of  delegates  from  a  large  majority  of  the  med- 
ical colleges  in  the  United  States  at  Cincinnati,  Ohio,  in 
1867.  After  three  days  of  free  and  friendly  discussion,  the 
convention  adopted,  with  considerable  unanimity,  resolutions 
declaring  that  a  fair  preliminary  education  equal  to  a  full 
academic  or  high  school  course  ought  to  be  required  of  all 
students  before  entering  upon  the  study  of  medicine ;  and 
that  the  time  of  medical  study  should  be  four  years,  in- 
cluding at  least  three  consecutive  annual  courses  of  graded 
medical  college  instruction  of  not  less  than  six  months  each, 
with  hospital  clinical  instruction  during  the  last  college  year. 

Moderate  and  reasonable  as  were  these  requirements 
only  one  medical  school  in  the  country  was  actually  carry- 
ing them  into  efifect  at  that  time.  That  was  the  Chicago 
Medical  College,  now  known  as  the  Northwestern  Univer- 
sity Medical  School,  which  was  founded  in  1859  o^  the  prin- 
ciples recommended  for  all  medical  schools  by  the  college 
convention  of  1867.  The  next  medical  school  that  adopted 
the  more  complete  system  of  medical  instruction  recom- 
mended by  the  college  convention  was  that  of  Harvard,  in 
Boston,  1872.  Pennsylvania  University  soon  followed,  and 
the  continued  discussions  in  the  medical  societies,  both  state 
and  national,  and  in  the  medical  periodicals,  finally  developed 
a  public  sentiment  that  caused  the  establishment  of  state  and 
local  boards  of  health  and  examination,  both  for  the  better 
protection  of  the  people  against  the  spread  of  contagious  dis- 
eases and  against  the  admission  of  unqualified  persons  to  the 
practise  of  medicine  in  any  of  its  departments. 

So  effectual  were  the  foregoing  influences  that  before  the 
close  of  the  nineteenth  century  the  requirement  of  a  fair 
academic  general  education  before  commencing  the  study  of 
medicine ;  four  years  of  medical  study,  including  attendance 
on  four  consecutive  or  graded  courses  of  medical  college  in- 
struction of  not  less  than  six  months  each,  with  ample  lab- 
oratory and  clinical  work  as  essential  parts  of  each  course. 


148 

had  become  the  established  system  of  medical  education 
throughout  the  United  States  of  America. 

The  same  influences  were  also  potent  in  establishing  more 
accurate  clinical  and  experimental  investigations  concerning 
the  causes  of  disease  and  the  operation  of  medicine.  The 
opportunities  alTorded  for  the  reading  of  papers  at  the  meet- 
ings of  medical  societies,  their  discussion  and  subsequent 
publication,  was  a  constant  stimulus  to  the  more  thoughtful 
and  industrious  members  of  the  profession,  which  was  often 
given  direction  by  the  offering  of  prizes  for  the  best  essays 
embodying  the  results  of  original  investigations,  and  the 
appointment  of  committees  to  report  on  the  prevailing  epi- 
demic and  zymotic  diseases,  and  on  the  sanitary  measures 
required  for  the  improvement  of  the  public  health. 

So  manifest  were  the  advantages  derived  from  the  more 
extensive  medical  organizations,  that  the  successful  progress 
of  the  British  and  American  Medical  Associations  was  soon 
followed  by  the  formation  of  a  triennial  International  Med- 
ical Congress,  which  has  brought  into  the  most  fraternal  and 
scientific  relations  the  members  of  the  medical  profession  of 
all  countries. 

The  rapid  and  important  advancements  made  during  the 
first  half  of  the  nineteenth  century  in  pathological  anatomy, 
physical  diagnosis  and  organic  chemistry,  as  detailed  in  a 
previous  chapter,  and  the  more  perfect  construction  of  micro- 
scopes in  1832,  prepared  the  way  for  equally  rapid  advance- 
ments in  the  chemistry  of  foods  and  their  assimilation  or 
uses  in  the  living  body ;  in  embryology  and  histology  or  mi- 
nute anatomy,  both  normal  and  pathological ;  and  in  aetiolo- 
g}^  especially  as  connected  with  bacteriolog>'  and  the  for- 
mation of  toxic  and  antitoxic  products  in  the  progress  of 
diseases. 

The  sweeping  and  plausible  classification  of  all  food 
substances  into  nitrogenous,  or  proteid,  and  non-nitrogenous, 
or  carbonaceous,  by  Baron  Liebig,  the  chief  founder  of  or- 
ganic and  physiological  chemistry,  and  the  division  of  all 
animal  tissues  into  nitrogenous  and  fatty  or  carbonaceous, 
gave  rise  to  the  purely  theoretical  assumption  that  only  the 
nitrogenous  food  elements  were  assimilated  and  used  for 


149 

the  growth  and  repair  of  the  organized  structures,  while 
the  carbonaceous  were  used  for  the  maintenance  of  animal 
heat  by  union  with  the  oxygen  furnished  by  respiration. 
At  first,  the  union  of  the  carbonaceous  food  elements  with 
oxygen,  resulting  in  the  formation  of  carbonic  acid  and 
water  with  the  evolution  of  heat,  was  thought  to  take  place , 
directly  in  the  pulmonary  capillaries.  Hence  they  were 
called  supporters  of  respiration  and  of  animal  heat;  and 
various  theories  were  invented  to  account  for  the  equal  dis- 
tribution of  the  heat  to  all  parts  of  the  system.  However, 
more  accurate  analyses  of  the  blood  in  different  parts  of  the 
living  body  and  from  both  veins  and  arteries  soon  demon- 
strated the  fact  that  instead  of  combustion  or  oxidation  tak- 
ing place  in  the  lungs  the  blood  currents  passing  the  pul- 
monary capillaries  simply  imbibed  the  oxygen  from  the  air 
cells  and  conveyed  it  free  to  the  systematic  capillaries  in  the 
various  structures  of  the  body,  and  the  carbonic  acid  sus- 
pended in  the  venous  blood  passed  into  the  air  cells  and  was 
exhaled  with  the  expired  air.  The  supposed  combustion  or 
union  of  oxygen  with  the  carbonaceous  food  elements  and 
evolution  of  heat  was  thus  transferred  from  the  pulmonary 
to  the  systematic  capillaries.  But  this  did  not  diminish  the 
general  confidence  of  the  public  in  the  chemical  theory  that 
these  elements  were  used  in  the  living  body  only  as  support- 
ers of  combustion  for  the  evolution  of  heat,  by  uniting  with 
the  free  oxygen  in  the  arterial  blood,  and  leaving  as  material 
products  carbonic  acid  and  water.  The  chief  elements  com- 
posing this  class  of  foods,  as  arranged  by  Liebig,  were 
starch,  sugar  or  glucose,  gum,  fat  or  oils,  and  alcohol  as  it 
exists  in  fermented  and  distilled  liquors. 

The  four  first  named  were  well  known  products  of  vege- 
table and  animal  growth,  constituting  a  large  part  of  the 
cereal  grains,  tuberous  roots,  and  many  kinds  of  fruit;  but 
the  fifth — alcohol — though  composed  of  the  same  three  ele- 
ments, carbon,  hydrogen  and  oxygen,  instead  of  being  a 
product  of  vegetable  or  animal  growth  was  well  known  to 
be  a  product  of  destructive  fermentation,  i.  e.,  a  bacteriolog- 
ical excretion,  and  capable  of  producing  very  different  ef- 
fects on  the  human  body  than  by  any  other  recognized  ele- 


150 

ment  of  food.    While  the  placing  of  alcohol  at  the  head  of 

the  class  of  carbonaceous  foods  by  Liebig  greatly  encour- 
aged its  popular  use  in  all  the  countries  of  Europe  and 
America,  its  correctness  was  challenged  by  several  men 
eminent  in  the  departments  of  chemistry  and  physiolog)\ 
It  was  soon  demonstrated  by  the  experiments  of  AOI. 
Tiedemann  and  Gmelin,  Bouchardat  and  Sandras,  John  Per- 
cy, Christison  and  others,  that  when  alcohol  was  taken  into 
the  stomach  diluted  as  in  fermented  and  distilled  liquors,  it 
was  directly  absorbed  by  the  portal  veins  unchanged  and 
passing  through  the  liver  and  lungs  was  speedily  detected 
in  the  arterial  blood,  the  liver,  lungs  and  brain,  and  in  the 
urine  and  exhaled  breath.  They  found  none,  however,  either 
in  the  lacteals,  the  chyle  or  in  the  thoracic  duct. 

Sir  Benj.  Brodie  found  it  was  readily  absorbed  and 
produced  its  usual  effects  after  the  thoracic  duct  had  been 
tied;  and  Dr.  Prout,  of  London,  clearly  showed  that  while 
it  was  present  in  the  blood  the  amount  of  carbonic  acid  or 
carbon  dioxide  in  the  air  exhaled  from  the  lungs  was  no- 
tably diminished.  And  Bocker,  of  Germany,  demonstrated 
by  a  patiently  executed  series  of  experiments  that  the  pres- 
ence of  alcohol  in  the  living  body  diminished  the  sum  total 
of  excretions  and  eliminations  therefrom. 

Notwithstanding  all  these  evidences  that  the  behavior 
of  alcohol  in  the  digestive  organs  was  wholly  unlike  that  of 
any  other  known  food,  either  carbonaceous  or  nitrogenous, 
and  that  its  presence  in  the  blood  diminished  both  the  ex- 
halation of  carbon  dioxide  and  tissue  metabolism,  they  were 
given  but  little  attention,  and  alcohol  was  continued  at  the 
head  of  the  list  of  heat  and  strength  producing  foods  by 
nearly  all  contributors  to  medical  and  general  literature. 
And  almost  every  family  was  induced  to  keep  on  hand  some 
kind  of  alcoholic  liquor,  if  not  for  daily  use  yet  to  meet  the 
emergencies  of  exposures  to  cold  or  wet  or  excessive  fa- 
tigue or  special  weakness  from  any  cause.  Consequently 
faith  in  the  power  of  alcohol  to  warm  and  strengthen  the 
living  body  became  thoroughly  fixed  in  the  popular  mind ; 
and  all  of  its  evil  effects  were  attributed  to  its  abuse.  In 
other  words,  it  was  claimed  by  Liebig  and  his  chemiccv-phys- 


^51 

iological  folowers,  that  alcohol  in  moderate  doses  was  a  true 
strengthening  and  heat-producing  food,  and  became  an  an- 
aesthetic or  paralyzing  agent  only  when  taken  in  large  doses. 
The  same  physiological  distinction  between  the  influence 
of  small,  or  moderate,  and  large  doses  was  soon  extended  to 
nearly  all  known  anaesthetic  and  narcotic  drugs ;  thus  intro- 
ducing into  all  our  works  on  therapeutics  and  practical  med- 
icine the  paradox  in  drug  action,  viz.,  that  in  moderate  doses 
they  were  stimulating,  supporting  and  warming  and  in  larger 
doses,  sedative,  narcotic  and  paralyzing. 

Being  dissatisfied  with  this  alleged  antagonistic  action  of 
small  and  large  doses  of  the  same  drugs,  and  wholly  unable 
to  reconcile  the  doctrine  of  Liebig  concerning  the  entire 
separate  action  and  uses  of  the  nitrogenous  and  carbonaceous 
classes  of  food,  either  with  the  results  of  investigations  al- 
ready mentioned  or  with  the  well  known  facts  that  AVhole 
classes  of  people  in  different  countries  lived  almost  wholly 
on  carbonaceous  foods  and  yet  were  robust  and  strong,  and 
that  laboring  men  who  took  daily  a  regular  ration  of  alco- 
holic drink  accomplished  less  work  and  suffered  more  from 
sickness  than  total  abstainers  working  side  by  side  with 
them,  (see  brick-makers  work  in  British  and  Foreign  Med- 
ico-Chinirgical  Review  for  Oct.,  1847),  ^  decided  to  in- 
stitute further  experimental  investigations,  for  the  purpose 
of  determining  more  reliably  the  sources  of  animal  heat  in 
conditions  of  health. 

For  this  purpose  during  the  years  1849  and  1850  I  de- 
vised and  executed  five  series  of  experiments.  The  first  was 
for  determining  the  actual  variations  in  the  temperature  of 
the  body  during  the  24  hours  while  taking  an  ordi- 
nary mixed  diet  and  the  usual  exercise,  and  the  coinci- 
dent variations  in  the  pulse  and  amount  of  exhaled  carbon 
dioxide.  During  two  weeks  the  temperature,  as  indicated 
by  a  delicately  graduated  thermometer  bulb  under  the 
tongue,  was  recorded  six  times  each  day,  i.  e.,  at  7 :30  A.  j\I., 
before  breakfast;  at  10:  A.  M.,  two  hours  after  breakfast; 
at  12:30  P.  M.,  before  dinner;  at  3.  P.  M.,  two  and  a  half 
hours  after  dinner;  at  5:30  P.  M.,  before  supper;  and  at 
8.  P.  M.,  two  hours  after  supper.    At  the  same  hours  a  rec- 


152 

Orel  was  made  of  the  proportion  of  carbon  dioxide  in  the 
exhaled  air.  The  records  of  each  day  uniformly  showed 
the  lowest  temperature  at  7 130  A.  M.,  after  the  long  fast  of 
the  night,  an  increase  of  about  2^  F.  during  the  two  hours 
after  breakfast ;  then  a  gradual  decline  until  after  dinner, 
when  it  increased  again,  attaining  the  highest  temperature 
at  3.  P.  i\I.,  two  hours  after  dinner;  then  receding  slowly 
until  the  supper,  when  another  but  less  degree  of  rise  took 
place;  thus  showing  that  in  a  strictly  healthy  condition,  and 
on  an  ordinary  mixed  diet  of  animal  and  vegetable  food, 
the  temperature  of  the  human  body  uniformly  rises  from 
I"'  F.  to  2^  F.  during  the  period  of  active  digestion  and  as- 
similation of  food  and  returns  to  the  minimum  during  fast- 
ing. The  same  records,  however,  showed  that  the  varia- 
tions in  the  quantity  of  carbon  dioxide  exhaled  from  the 
lungs  were  not  parallel  with  the  variations  of  temperature ; 
the  greatest  amount  exhaled  daily  being  from  3.  P.  M.  to 
6.  P.  ]\I.,  then  decreasing  slowly  until  10  A.  M. 

Having  thus  ascertained  the  actual  temperature  and  the 
ratio  of  carbon  dioxide  in  the  exhaled  air  and  their  daily 
variations  under  an  ordinary  mixed  diet,  the  same  indi- 
vidual made  the  same  observations  and  records  with  the 
same  instruments  during  three  consecutive  days  on  a  diet 
exclusively  carbonaceous,  consisting  of  starch  and  white 
sugar.  Then  after  living  on  the  usual  mixed  diet  one  week, 
the  same  observations  and  records  were  made  with  the  same 
appliances  during  three  days  on  a  diet  exclusively  nitro- 
genous, consisting  of  tg%  albumen  carefully  separated  from 
the  yolk. 

The  records  of  both  these  series  of  observations  showed 
the  same  increase  of  temperature  during  active  digestion 
after  each  meal  as  had  been  recorded  under  a  mixed  diet. 
The  only  difference  was  that  the  temperature  rose  more 
rapidly  after  each  meal  of  starch  and  sugar,  and  slower  after 
the  meals  of  albumen,  plainly  on  account  of  the  more  rapid 
digestion  of  the  carbonaceous  food,  for  the  average  daily 
temperature  under  the  exclusively  carbonaceous  diet  was 
.5^  F.  lower  than  under  either  the  mixed  or  exclusive  proteid 
food. 


153 

The  fourth  series  of  observations  and  records  were  made 
to  determine  the  effects  of  alcohol  on  the  temperature,  pulse 
rate,  and  exhaled  carbon  dioxide.  To  prevent  the  results 
from  being  complicated  by  the  coincident  action  of  other 
food  the  time  chosen  for  commencing  the  experiments  with 
alcohol  was  nine  o'clock  in  the  evening,  three  hours  after 
the  evening  meal.  After  noting  the  temperature,  pulse  rate, 
and  the  ratio  of  carbon  dioxide  exhaled,  four  ounces  of 
brandy  were  taken  at  once  diluted  with  water.  In  less  than 
fifteen  minutes  a  sense  of  heat  was  felt  in  the  stomach  and 
face,  with  a  feeling  of  mental  exhilaration  and  less  con- 
sciousness of  external  impressions  and  at  the  end  of  one 
hour  the  temperature  was  not"  appreciably  altered,  the  pulse 
had  increased  five  beats  per  minute,  and  the  amount  of  car- 
bon dioxide  being  exhaled  had  diminished.  At  the  end  of 
two  hours  the  temperature  had  diminished  .2^  F.,  the  pulse 
had  returned  to  its  natural  frequency,  and  the  ratio  of  carbon 
exhaled  was  still  less  than  at  the  beginning. 

At  the  end  of  three  hours  the  temperature  had  fallen 
.50  F.,  while  the  pulse  and  ratio  of  exhaled  carbon  had  re- 
turned to  the  natural  standard  before  the  brandy  was  taken, 
but  the  benumbing  effect  on  the  brain,  mental  faculties,  and 
voluntary  muscular  movements  was  still  obvious, 

A  few  evenings  later  the  experiment  was  repeated  with 
about  the  same  quantity  of  alcohol  in  the  form  of  port  wine, 
and  with  the  same  results  in  all  respects. 

The  foregoing  records,  so  far  as  they  relate  to  temporary 
increased  frequency  of  pulse  and  diminished  exhalation  of 
carbon  dioxide,  are  in  strict  accord  with  those  previously 
recorded  by  Front,  Bouchardat  and  Sandras,  but  they  con- 
stituted the  first  clear  demonstration  that  the  presence  of 
alcohol  in  the  human  body  reduced  the  temperature,  and 
lessened  the  sensibility  of  the  nervous  structures  generally; 
effects  entirely  different  from  those  obtained  from  the  tak- 
ing of  any  other  known  food,  either  carbonaceous  or  proteid. 

The  fifth  experimental  inquiry  related  to  the  origin  and 
uses  of  the  fibrin  of  the  blood,  which  up  to  that  time,  1850, 
had  been  universally  regarded  as  the  most  perfectly  assim- 
ilated constituent  and  used  for  the  growth  and  repair  of  the 


154 

fibrous  and  muscular  structures  of  the  body.  Yet  the  nu- 
merous analyses  of  blood  by  Andral,  Gavaret,  Rodier,  Si- 
mon and  others,  had  shown  that  the  relative  proportion  of 
fibrin  was  greatest  during  the  progress  of  acute  inflamma- 
tions, when  digestion  and  assimilation  were  much  dimin- 
ished ;  in  protracted  anaemia ;  and  even  in  the  advanced  stage 
of  pulmonary  tuberculosis  when  emaciation  was  progressing 
most  rapidly. 

These  facts  were  inconsistent  with  the  claim  that  the 
fibrin  was  a  direct  product  of  food  assimilation,  and  sug- 
gested the  inquiry  whether  it  might  not  be  a  product  of  ret- 
rograde tissue  metabolism.  Indeed,  Simon  had  suggested 
that  the  fibrin  was  derived  from  the  disintegration  of  the 
red  corpuscles  and  in  his  work  on  the  "Chemistry  of  Man" 
page  139,  he  gives  the  results  of  analyses  of  the  blood  from 
the  aorta,  and  from  the  renal  and  hepatic  veins  of  a  horse, 
showing  very  marked  diminution  of  the  fibrin  in  the  blood 
returning  from  the  actively  excreting  organs.  It  was  stated, 
however,  that  the  horse  was  not  in  a  healthy  condition  and 
the  amount  of  blood  from  the  renal  vein  not  sufficient  for  a 
satisfactory  analysis.  Regarding  the  question  as  important, 
I  secured  an  ample  supply  of  blood  from  the  iliac  artery,  the 
iliac  vein,  and  the  renal  vein  of  a  healthy  dog  and  subjected 
each  specimen  to  a  careful  analysis  by  which  it  was  shown 
that  the  blood  in  the  iliac  vein  contained  notably  more  fibrin 
than  that  from  the  artery,  while  that  from  the  renal  vein  con- 
tained very  much  less,  thereby  showing  clearly  that  the 
blood  while  passing  through  a  muscular  and  non-secreting 
structure  gained  in  its  proportion  of  fibrin,  and  the  reverse 
in  passing  through  an  actively  excreting  organ. 

The  results  of  all  the  foregoing  series  of  experimental 
investigations  were  embodied  in  an  essay  entitled  "An  Ex- 
perimental Inquiry  concerning  some  points  in  the  Vital 
Processes  of  Assimilation  and  Nutrition",  and  read  in  the 
annual  meeting  of  the  American  Medical  Association,  at 
Charleston,  S.  C,  May,  185 1. 

The  general  conclusions  set  forth  by  the  essayist  were 
"that  the  carbonic  acid  of  the  respiratory  process,  like  the 
secretions  of  the  skin  and  kidneys,  is  a  true  product  of  the 


155 

metamorphosis  of  the  structures  of  the  body,  while  the  tem- 
perature depends  directly  on  those  changes  which  take  place 
in  the  nutritive  and  organic  actions;"  *  *  *  "that  all 
digestible  substances,  whether  carbonaceous  or  nitrogenous, 
are  assimilated  and  appropriated  with  more  or  less  facility 
to  the  nourishment  of  the  organized  structures  of  the  body ;" 
*  *  *  "that  alcohol  produced  none  of  the  effects  of  food, 
but  permeated  the  blood  and  tissues  like  other  well  known 
drugs;  and  that  the  fibrin  of  the  blood  was  a  product  of 
tissue  waste  to  be  eliminated  by  the  kidneys  and  perhaps  oth- 
er excretory  organs."  The  essay  was  listened  to  attentive- 
ly and  a  vote  of  thanks  tendered,  but  its  facts  and  inferences 
were  so  directly  opposed  to  the  then  popular  chemico-phys- 
iological  doctrines,  that  no  vote  for  publication  was  passed. 
It  was,  however,  published  in  full  in  the  Northwestern 
Medical  and  Surgical  Journal,  Chicago,  September,  1851, 
pp.  169-190. 

In  the  autumn  of  1852,  aided  by  Dr.  Henry  Parker,  then 
a  resident  of  Chicago,  I  repeated  and  varied  my  experiments 
concerning  the  effects  of  alcohol  in  the  form  of  both  wine 
and  brandy,  noting  more  particularly  its  effects  on  the  func- 
tions of  the  cerebro-spinal  nervous  systems,  both  voluntary 
and  involuntary,  in  addition  to  that  of  respiration  and  animal 
heat.  The  results  obtained  fully  sustained  the  correctness 
of  the  conclusions  stated  in  the  essay  of  185 1,  and  they  were 
used  by  Dr.  Henry  Parker  as  the  basis  of  his  "Prize  Essay 
on  the  Difference  between  Stimulants  and  Tonics",  presented 
to  the  annual  meeting  of  the  Illinois  State  Medical  Society, 
in  La  Salle,  1854,  and  published  in  the  volume  of  transac- 
tions for  that  year.  At  this  time  an  eminent  physician  of 
Boston  suggested  that  inasmuch  as  the  moderate  use  of  al- 
coholic drinks  lessened  tissue  waste  and  favored  the  ac- 
cumulation of  fat,  their  use  might  be  of  value  in  the  treat- 
ment of  pulmonary  tuberculosis  and  other  wasting  diseases. 
The  suggestion  was  received  with  favor,  and  during  the 
first  two  decades  of  the  last  half  of  the  nineteenth  century 
cod-liver  oil  and  Bourbon  whiskey  were  the  most  popular 
remedies  both  for  the  prevention  and  cure  of  pulmonary 
tuberculosis. 


156 

On  this  account  I  was  led  to  commence  making  full  rec- 
ord of  every  well  marked  case  of  pulmonary  tuberculosis 
that  came  under  my  care,  both  in  hospital  and  private  prac- 
tice, of  which  a  reliable  account  could  be  obtained  concern- 
ing the  use  of  alcoholic  drinks  both  before  and  during  the 
progress  of  the  disease.  During  the  four  years  interv^ening 
between  1855  and  the  end  of  1859,  I  had  accumulated  full 
notes  of  210  cases,  of  whom  140  were  males  and  70  females. 
Of  the  whole  number  68  had  used  some  form  of  alcoholic 
drink  almost  daily  from  one  to  twelve  years  before  any 
symptoms  of  tuberculosis  were  observed.  Some  had  drunk 
only  beer  at  the  rate  of  three  or  four  glasses  a  day;  some 
had  drunk  chiefly  wine;  and  a  larger  number  had  taken  all 
kinds  of  liquor.  They  were  all  habitual  drinkers,  yet  only 
15  were  recognized  as  drunkards.  Ninety-one  were  period- 
ical or  irregular  drinkers  of  alcoholic  liquors,  but  rarely 
became  intoxicated;  and  53  had  been  total  abstainers  from 
alcohol  through  life.  Many  of  those  belonging  to  the  class 
of  habitual  drinkers  were  in  such  circumstances,  and  with 
such  habits  as  were  as  favorable  for  testing  the  influence  of 
alcohol  on  the  development  of  tuberculosis  as  could  have 
been  devised.  But  instead  of  aflfording  evidence  of  any  pre- 
ventive or  retarding  influence,  the  use  of  alcohol  appeared 
to  both  favor  attacks  of  the  disease  and  to  hasten  its  prog- 
ress towards  a  fatal  termination.  The  cases  in  all  their 
bearings  were  included  in  a  paper  read  in  the  Medical  Sec- 
tion of  the  American  Medical  Association  at  its  annual  meet- 
ing in  New  Haven,  Conn.,  May,  i860,  and  published  in  the 
volume  of  transactions  of  the  Association  for  that  year. 

At  the  annual  meeting  of  the  American  Medical  Associa- 
tion in  May,  1857,  Dr.  \Vm.  A.  Hammond,  then  a  mem- 
ber of  the  [Medical  Staff  of  U.  S.  Army,  presented  an  essay 
to  which  was  awarded  a  prize,  and  w^hich  embraced  a  full 
account  of  the  eft'ects  of  living  ten  consecutive  days  ex- 
clusively on  albumen  and  water,  and  at  another  time  on  noth- 
ing but  starch  and  water.  During  the  diet  of  albumen  he 
lost  five  pounds  in  body  weight  but  without  any  loss  of  tem- 
perature. During  the  ten  days  on  starch  alone  he  lost  no 
body  weight  and  gained  slightly  in  temperature.    His  con- 


157 

elusions  were  "that  albumen  may  be  assimilated  into  the 
system  in  such  quantity  as  to  affoid  a  sufficiency  of  both 
nitrogen  and  carbon  for  the  organism;"  and  "that  starch  can 
be  assimilated  by  the  absorbents  m  more  than  sufficient  quan- 
tity to  sustain  the  respiratory  function."  In  other  words 
that  both  albumen  and  starch  were  capable  of  assimulation 
and  use  as  food  for  the  organized  structures  of  the  body 
(see  Trans,  of  Amer.  Med.  Association,  Vol.  lo,  p.  511, 
1857).  Subsequently  Dr.  Hammond  instituted  valuable  ex- 
periments with  alcohol,  first  on  the  dog,  and  afterwards  on 
himself.  When  he  introduced  alcohol  diluted  with  waiter 
into  the  stomach  of  a  dog  it  was  quickly  absorbed  and 
readily  detected  in  the  blood,  the  various  organized  struc- 
tures of  the  body,  in  the  urine,  and  the  exhalations  from  the 
lungs. 

He  executed  three  series  of  experiments  on  himself  not 
by  attempting  to  live  on  alcohol  alone,  as  in  the  experiments 
with  albumen  and  starch,  but  by  taking  for  five  days  four 
drachms  of  alcohol  diluted  with  an  equal  quantity  of  water 
in  connection  with  each  meal  of  ordinary  food.  During  each 
of  the  three  experimental  series  of  five  days  he  found  the 
amount  of  carbon  dioxide  and  water  exhaled  notably  dimin- 
ished ;  the  urine  decreased  both  in  quantity  and  in  solid  con- 
stituents ;  pulse  increased  in  frequency ;  decided  headache 
with  sense  of  heat  in  the  surface,  and  indisposition  to  exer- 
tion either  physical  or  mental ;  but  at  the  end  of  each  five 
days  he  had  increased  a  few  ounces  in  weight.  These  re- 
sults showed  very  plainly  that  the  alcohol,  instead  of  acting 
as  respiratory  food,  actually  diminished  the  sensibility  of  all 
the  nervous  structures  as  an  anaesthetic,  and  retarded  the 
metabolic  and  excretory  functions.  An  account  of  Dr.  Ham- 
mond's experiments  may  be  found  in  his  Treatise  on  Hy- 
giene published  in  1863. 

During  the  years  1865-66,  Dr.  Benj.  Ward  Richardson, 
of  London,  was  led  to  test  by  accurate  experiments  the  ef- 
fects of  alcohol  on  the  temperature  of  the  human  body,  and 
was  surprised  to  find  that  it  uniformly  reduced  the  same  in 
direct  proportion  to  the  quantity  used.  He  embodied  the  re- 
sults of  his  investigation  in  a  paper  presented  in  the  meeting 


of  the  British  Association  for  the  Advancement  of  Science, 
at  Birmingham,  in  1866.  After  some  discussion  the  paper 
was  regarded  with  so  much  increduhty  that  it  was  returned 
to  its  author  for  further  investigation ;  a  fate  very  similar 
to  that  awarded  to  my  own  paper  by  the  American  Medical 
Association  at  Charleston,  S.  C,  fifteen  years  previous,  but 
concerning  which  Dr.  Richardson  evidently  had  no  knowl- 
edge. His  paper,  however,  was  soon  published  and  attracted 
much  attention  both  in  Europe  and  x^merica ;  and  a  large 
part  of  his  subsequent  life  work  was  devoted  to  further  in- 
vestigations, public  lectures  and  publications,  advocating 
more  correct  views  concerning  the  nature  and  effects  of 
alcohol  on  the  human  system  in  health  and  in  conditions  of 
disease.  He  gained  a  very  high  reputation  in  both  literature 
and  science,  and  died  Nov.  21st,  1896,  as  Sir  Benjamin  Ward 
Richardson,  in  the  69th  year  of  his  age. 

Since  the  foregoing  investigations  by  myself.  Dr.  Ham- 
mond and  Dr.  Richardson  every  aspect  of  the  influence  of  al- 
cohol on  the  human  system  and  on  both  animal  and  vege- 
table life,  in  small  doses  and  large  doses,  aided  by  every  in- 
strument and  device  of  modern  invention  designed  to  secure 
accuracy  of  results,  has  been  thoroughly  investigated  by 
Professors  Martin,  Hammerton,  Eagleton  and  Gibbs  of 
Johns  Hopkins  University ;  Drs.  E.  T.  Reichert,  David  Cer- 
na,  J.  H.  Kellogg,  Beaumont,  Chittendon  and  Mendel,  C. 
F.  Hodge,  Berkley  and  Friedenwald,  A.  C.  Abbott,  I.  H. 
Orcutt,  H.  C.  Wood  and  Prof.  Atwater,  in  this  country. 
And  in  Europe  by  Parkes,  Anstie,  J.  J.  Ridge,  Ringer  and 
Sainsbury,  Kraepelin,  George  Harley,  Lauder  Brunton,  Li- 
onel Beale,  E.  Destree,  Galzinski,  Romanes  and  Krukenberg, 
F.  W.  D'Evelyn,  Mohilinski,  Charles  Fere,  Branthwaite,  H. 
Frey,  Delcarde,  ]\Iax  Kassowitz,  Laitinen  and  others.  A 
careful  rfeview  of  the  experimental  work  of  all  the  investi- 
gators heretofore  named,  shows  with  perfect  clearness  that 
alcohol  as  it  exists  in  fermented  and  distilled  liquors,  instead 
of  being  digested  and  assimilated  in  the  digestive  organs 
like  sugar,  starch  and  fat  or  other  carbonaceous  food  sub- 
stances, is  absorbed  unchanged  and  is  carried  in  the  blood 
to  every  part  of  the  living  body  the  same  as  ether,  chloro- 


159 

form,  morphine,  nicotine  and  other  anaesthetic  and  narcotic 
drugs.  That  while  present  it  lowers  the  temperature ;  di- 
minishes the  activity  of  natural  metabolism ;  lessens  the  force 
and  efficiency  of  the  circulation  and  respiration ;  impairs  the 
functions  of  all  nerve  structures,  both  sensory  and  trans- 
mitting, and  thereby  diminishes  the  acuteness  of  the  special 
senses  and  the  activity  of  mental  processes  in  direct  propor- 
tion to  the  quantity  used.  Also,  that  it  impairs  the  corpuscu- 
lar elements  of  the  blood,  lessens  the  activity  of  the  leuco- 
cytes, and  favors  tissue  degenerations  in  the  direction  of 
fatty,  fibroid  and  sclerotic  changes ;  that  it  diminishes  every 
force  or  energy  known  in  a  living  body,  i.  e.,  muscular,  nerve, 
mental,  heat  and  vital  or  protoplasmic  force,  and  thereby  di- 
rectly lessens  the  natural  vital  resistance  to  all  toxic  and 
disease  producing  agents  and  extends  the  same  from  parent 
to  offspring.  Like  all  other  general  anaesthetic  and  narcotic 
drugs  in  large  doses  it  destroys  life  by  paralyzing  the  func- 
tions of  respiration  and  circulation,  and  in  small  daily  re- 
peated doses  it  lessens  both  mental  and  physical  activity  and 
endurance,  and  yet  deceives  the  individual  by  lessening  the 
sensibility  of  his  material  seat  of  consciousness  in  the  brain. 
The  important  bearing  of  the  foregoing  facts  on  the 
public  health  and  morals  is  only  beginning  to  be  appreciated 
at  present,  but  before  the  end  of  the  twentieth  century  the 
numerous  investigations  by  which  they  have  been  established 
will  be  regarded  as  among  the  most  important  that  have 
characterized  the  progress  of  medicine  during  the  last  half 
of  the  nineteenth  century  of  the  Christian  era. 


i6o 


CHAPTER  XII. 

HISTORY  OF  MEDICAL  PROGRESS  DURING  THE  LAST  HALF  OF 
THE  NINETEENTH  CENTURY  COMPLETED.  THE  PRESENT 
STATUS  OF  MEDICAL  INVESTIGATIONS  AND  PROGRESS,  AND 
THE  INDICATIONS  OF  FURTHER  ADVANCEMENT. 

The  brilliant  and  important  advancements  in  organic 
chemistry  under  the*  leadership  of  Liebig  in  Germany;  in 
pathological  anatomy  and  physical  diagnosis  in  France;  in 
the  physiology  of  the  nervous  system  in  England ;  and  in 
anaesthesia  in  America  during  the  first  half  of  the  nineteenth 
century,  were  all  accomplished  by  close  observation  and  dili- 
gent experimental  application  of  chemical  and  physiological 
laws,  with  but  little  aid  from  the  microscope.  But  they 
paved  the  way  and  furnished  an  excellent  basis  for  the 
no  less  brilliant  achievements  of  the  last  half  of  the  same 
century.  The  compound  microscope  was  brought  to  a  de- 
gree of  completion  in  1832  that  enabled  other  investigators 
to  take  the  several  primary  structures  of  the  anatomists  and 
resolve  them  into  the  individual  cells  or  organized  atoms  of 
which  they  were  composed,  thereby  showing  the  manner  of 
their  evolution  or  growth,  and  developing  the  interesting 
departments  of  histology  and  embryology. 

Under  the  leadership  of  Thomas  Schwann,  Lionel  S. 
Beale,  Louis  Agassiz,  Sharpey,  Hassall,  Bastian,  Tyndal, 
Huxley,  Virchow,  and  others,  every  organized  structure  of 
the  living  body  was  subjected  to  microscopic  analyses  and 
found  to  be  composed  of  individual  cells,  varying  in  size  and 
shape,  and  performing  a  great  variety  of  functions,  but  all 
composed  essentially  of  an  organizable  substance  recognized 
as  the  physical  basis  of  life,  and  called  by  some  investigators 
protoplasm  and  by  others  bioplasm.  Its  most  distinctive  at- 
tribute is  its  vital  capacity  to  grow  and  multiply  or  propa- 
gate itself.  Thus  they  found  all  living  bodies,  both  animal 
and  vegetable,  composed  of  protoplasm  aggregated  in  mi- 
nute forms  called  cells,  and  united  in  various  ways  to  con- 
stitute all  the  organized  matter  in  the  fluids  and  solids  of 


i6i 

living  bodies, — a  beautiful  histological  demonstration,  that 
may  well  remind  us  of  the  crude  theory  of  atoms  and  pores 
taught  by  Asclepiades  and  his  pupil  Themison,  one  hundred 
and  fifty  years  before  the  commencement  of  the  Christian 
era. 

The  modern  investigators  did  not  limit  their  microscop- 
ic analyses  to  normal  structures,  but  extended  them  with 
equal  diligence  to  all  the  morbid  structures  and  products 
brought  to  light  by  the  studies  in  morbid  anatomy  during 
the  first  half  of  the  century.  This  soon  resulted  in  demon- 
strating that  all  tumors  or  morbid  growths  were  cellular  in 
structure,  and  progressive  by  constant  evolution  of  new 
cells;  and  the  so-called  inflammatory  exudations,  whether 
plastic  or  aplastic,  were  also  composed  of  cells  derived  from 
the  blood  and  tissues.  The  plastic  exudations  were  found 
to  consist  largely  of  white  corpuscles  or  leucocytes,  formerly 
called  migrating  corpuscles.  They  were  seen  to  attack  and 
apparently  consume  such  offending  matter  as  they  met  with, 
and  soon  after  to  disappear  leaving  the  structure  in  its  nor- 
mal condition,  or  if  their  accumulation  was  too  great  or  per- 
sistent, they  united  in  the  formation  of  adventitious  tissue 
by  which  thickenings,  indurations  or  adhesions  might  remain 
for  indefinite  periods  of  time.  If  the  exudations  were  aplas- 
tic from  the  presence  of  pathogenic  bacteria,  or  their  toxic 
products,  the  vitality  of  the  accumulated  leucocytes  was 
overwhelmed  and  they,  with  the  cells  of  the  tissues,  were  de- 
generated into  pus  corpuscles  with  more  or  less  destruction 
of  tissue  by  ulceration,  suppuration  or  gangrene. 

From  all  the  foregoing  investigations  the  eminent  Ger- 
man pathologist,  Rudolph  Virchow,  was  enabled  to  give  to 
the  world  his  great  work  on  cellular  pathology  (Cellular 
Pathologic)  published  in  1858,  which  was  translated  into 
French  by  Picard  and  into  English  by  Frank  Chase  in  i860. 

While  one  class  of  investigators  was  thus  successfully 
using  the  microscope  to  enable  them  to  see  more  clearly  the 
composition  and  modes  of  development  of  living  organized 
structures,  both  in  conditions  of  health  and  disease,  and 
thereby  creating  anew  the  important  departments  of  normal 
and  pathological  histology,  another  class  consisting  of  J.  K. 


1 62 

Mitchell,  Saulsbury,  Sanderson,  Beale,  Lister,  Pasteur, 
Koch,  Sternberg,  E.  Hallier,  and  many  others,  both  in  Eu- 
rope and  America,  were  applying  the  same  instrument  with 
equal  diligence  in  the  domain  of  aetiology,  searching  for 
long-hidden  causes  of  disease. 

In  all  the  earlier  periods  of  medical  history  most  of  the 
febrile  and  inflammatory  diseases  were  attributed  to  the 
concoction  or  fermentation  of  the  blood  and  other  so-called 
humors  in  the  living  body.  Later,  by  observation  alone,  the 
concoctions  causing  the  active  phenomena  of  diseases  were 
traced  in  some  instances  to  something  emanating  from  moist 
soils  rich  in  decomposable  vegetable  matter  and  exposed 
to  high  temperature.  Other  cases  were  traced  to  the  influ- 
ence of  the  air  in  over-crowded  and  ill-ventilated  houses  and 
the  use  of  impure  water.  By  long-continued  observations 
the  profession  became  satisfied  that  the  combined  influence 
of  heat,  moisture  and  decomposable  vegetable  matter  in  the 
soil,  gave  rise  to  a  subtle  toxic  agent  capable  of  impregnat- 
ing both  air  and  water,  that  was  called  Malaria  or  Koino- 
miasm.  By  similar  observations  it  was  made  evident  that 
both  air  and  water,  when  impregnated  with  the  excretions 
and  eliminations  from  living  animal  bodies,  became  toxic 
and  capable  of  producing  a  variety  of  severe  and  often  fatal 
febrile,  diseases.  When  the  science  of  analytical  chemistry 
had  reached  a  high  degree  of  development,  many  samples 
of  supposedly  impure  soil,  water  and  air  were  subjected  to 
rigid  chemical  analysis,  hoping  thereby  to  isolate  and  iden- 
tify the  specific  toxic  agents  called  miasms,  but  without  suc- 
cess. But  when  the  same  substances  were  properly  placed 
in  the  field  of  the  microscope  an  abundance  of  living  germs, 
called  bacteria,  were  discovered  and  found  capable  of  prop- 
agation on  suitable  media  in  the  laboratory.  Copeland  and 
a  few  earlier  writers  under  the  phras?  "contagium  vivum" 
had  suggested  that  the  specific  causes  of  some  epidemic  and 
contagious  fevers  consisted  of  sporules  or  fungi ;  and  in 
1849  ^r-  J-  ^-  Mitchell,  of  Philadelphia,  published  a  very 
interesting  monograph  on  the  subject.  He  w^as  followed  by 
Dr.  Salsbury,  of  Cleveland,  Ohio,  in  1866,  who  published 
two  papers,  giving  the  results  of  his  own  investigations  con- 


i6s 

ceming  a  vegetable  fungus  called  palmella.  Still  later  Drs. 
Klebs,  and  Thomasini  Crudelli,  of  Italy,  experimented  with 
a  fungoid  growth  found  in  the  malarious  soils  near  Rome 
that  they  called  bacillus  malaria;,  and  claimed  to  have  dem- 
onstrated its  causative  influence  by  inoculating  rabbits  with 
it.  Their  conclusions,  however,  were  not  sustained  by  a 
thorough  experimental  investigation  by  Dr.  Geo.  M.  Stern- 
berg, U.  S.  A.,  in  a  highly  malarious  district  in  Louisiana. 
Laveran  and  others  extended  their  examinations  to  the  blood 
of  patients  during  the  active  progress  of  malarious  fevers, 
and  soon  identified  the  supposed  specific  cause  in  the  red 
corpuscles  of  the  blood  in  the  form  of  the  plasmodium  ma- 
larite. 

When,  during  the  decade  following  i860,  it  was  shown 
by  Huxley,  Beale,  Bastian  and  others  that  microscopic  germs 
or  fungi  pervaded  the  atmosphere  and  were  greatly  increased 
both  in  number  and  variety  in  the  air  of  over-crowded  and 
unventilated  rooms ;  and  the  process  of  fermentation  was 
shown  by  Pasteur  to  be  one  of  bacteriological  development, 
not  a  few  of  the  investigators  regarded  the  bacteria  as  the 
product  of  spontaneous  growth.  Bastian  published  a  large 
work  in  support  of  that  doctrine.  But  all  his  positions  were 
soon  completely  refuted  by  the  further  investigations  of 
Huxley,  Pasteur,  Beale^  Virchow,  and  others,  showing  that 
in  all  instances  living  germs  are  developed  only  from  pre- 
ceding germs.  They  proved  conclusively  not  only  that  "like 
begets  like",  but  also  that  every  living  cell  and  germ,  wheth- 
er vegetable  or  animal,  is  evolved  from  a  preceding  cell  or 
germ. 

In  1835  Bassi  and  Belasma  discovered  the  silk  worm 
fungus,  and  in  1855  Polender  discovered  the  bacillus  of  ma- 
lignant pustule.  In  1847  Joseph  Leidy,  of  Philadelphia, 
demonstrated  the  existence  of  the  trichina  spiralis,  pre- 
viously described  by  Richard  Owen,  in  pork,  and  its  com- 
municability  to  man.  During  the  decade  following  i860, 
Pasteur  demonstrated  fully  that  without  the  presence  of 
micro-organisms  there  could  be  neither  fermentation  nor  de- 
cay. It  was  during  the  same  period  of  time  that  Devalue 
proved  his  previously  discovered  germ  in  the  blood  of  an- 


164 

imals  suffering  from  anthrax  to  be  the  cause  of  that  dis- 
ease ;  and  Oertel  discovered  fungi  in  the  exudations  accom- 
panying diphtheria,  which  were  more  accurately  described 
later  by  Klebs  and  Loeffler  as  bacilli. 

Early  in  the  next  decade  (1873)  Obermeier  discovered 
the  spirochaete  in  the  blood  of  recurrent  fever  patients,  and 
Joseph  Lister  prosecuted  his  investigations  concerning  the 
micro-organisms  of  suppurating  wounds,  erysipelas,  and 
septicaemia,  by  which  he  was  enabled,  in  1878,  to  propose 
a  system  of  antiseptic  surgical  practice  that  speedily  effected 
a  most  beneficial  revolution  in  the  treatment  of  all  wounds 
and  surgical  diseases. 

The  decade  following  1880  was  equally  remarkable  for 
the  microscopic  achievements  in  the  department  of  aetiology. 
It  was  at  the  beginning  of  that  decade  the  announcement 
of  the  fungus  of  actinomycosis  by  Bottinger  began  to  at- 
tract attention,  and  Prof.  James  Law,  of  Ithaca,  N.  Y.,  dem- 
onstrated its  existence  in  1883.  The  following  year  Drs. 
W.  T.  Belfield  and  J.  B.  Murphy  presented  two  well-marked 
cases  of  the  disease  in  the  human  subject,  before  the  Chicago 
IMedical  Society,  and  the  specific  microbe  was  identified  by 
Drs.  Belfield  and  Fenger. 

In  1885  Pasteur  commenced  his  inoculations  for  pre- 
venting hydrophobia  in  human  subjects. 

In  1886,  Koch  announced  his  discovery  of  the  cholera 
bacillus;  in  1887  the  bacillus  of  tuberculosis,  and  that  of 
tetanus  soon  followed.  The  pneumococcus  of  pneumonia 
was  announced  by  Friedlander;  and  before  the  end  of  the 
century  the  numerous  workers  in  the  field  of  bacteriology 
had  claimed  nearly  all  the  diseases  in  the  catalogue  of  human 
ailments  as  resulting  from  pathogenic  germs  of  some  form. 

Apparently  the  first  thought  excited  by  all  the  foregoing 
discoveries,  both  in  relation  to  surgical  wounds  and  to  dis- 
ease-producing bacteria,  was  the  practical  application  of  an- 
tiseptics and  germicides  for  the  destruction  of  the  offending 
germs.  Consequently  the  shelves  of  the  apothecary  shops,  both 
wholesale  and  retail,  speedily  became  loaded  with  a  great  va- 
riety of  antiseptics,  germicides  and  antitoxins,  for  both  exter- 
nal and  internal  use.  Clinical  experience  in  their  use  soon  dem- 


i65 

onstrated  that  by  the  external  apphcations  a  much  greater 
degree  of  cleanUness,  of  both  patients  and  their  surround- 
ings, was  secured,  and  corresponding  improvements  in  the 
results  of  all  external  dressings  and  surgical  procedures. 
But  the  same  experience  with  their  internal  use,  for  the  pur- 
pose of  destroying  either  the  bacteria  or  their  toxins  already 
existing  in  the  blood  or  tissues,  resulted  in  only  a  limited 
degree  of  success.  As  soon  as  the  bacteriologist  announced 
the  discovery  of  a  pathogenic  germ,  or  its  toxin,  as  the  cause 
of  any  acute  disease,  the  clinician  began  to  administer  his 
germicide  or  antitoxin  in  all  stages  of  the  disease,  regardless 
of  the  previously  well  known  laws  of  development,  progress, 
and  decline,  in  all  acute  diseases. 

Every  pathogenic  germ  or  toxin  discovered  was  declared 
to  be  a  contagious  or  infectious  agent,  to  be  either  avoided 
by  isolation  or  directly  combatted  by  specific  germicides  or 
antitoxins. 

And  thus  the  nineteenth  century  closed  with  the  medical 
profession  throughout  Christendom  engaged  in  a  deter- 
mined effort  to  discover  the  specific  causes  of  diseases  and 
their  specific  remedies,  aided  by  all  the  modern  facilities  and 
appliances  for  ensuring  accuracy  in  the  domain  of  scientific 
research. 

The  results  thus  far  have  been  a  great  increase  in  our 
knowledge  of  the  causes  of  disease,  both  specific  or  ex- 
citing and  predisposing,  and  corresponding  advancements  in 
the  field  of  sanitary  or  preventive  medicine.  For  the  more 
extensive  and  accurate  our  knowledge  of  aetiological  agents, 
whether  in  air,  earth,  or  water,  the  more  successfully  can 
sanitary  measures  be  devised  for  their  avoidance  or  de- 
struction. 

But  the  administration  of  specific  remedies  for  the  pur- 
pose of  arresting  the  progress  of  active  or  acute  diseases 
caused  by  specific  germs  or  toxins  has  been  attended  by  only 
a  limited  degree  of  success.  This  remark  applies  to  the  use 
of  both  chemical  antiseptic  drugs  and  organic  extracts  or 
antitoxic  sera.  In  their  zeal  both  laboratory  investigators 
and  clinicians  apparently  overlooked  the  fact  that  all  acute 
febrile  diseases  are  characterized  by  a  stage  of  incubation, 


i66 

a  prodromic  or  forming  stage,  a  stage  of  active  progress, 
and  a  stage  of  decline  or  death.  So  too,  all  the  well  known 
pathogenic  bacteria  that  cause  febrile  attacks  have  a  period 
of  incubation  after  they  are  introduced  into  the  living  body, 
followed  by  a  period  of  rapid  multiplication,  during  which 
they  commence  the  evolvement  of  a  toxic  ptomain  that  be- 
comes the  direct  excitor  of  the  active  phenomena  of  disease, 
and  continues  the  same  until  overcome  by  the  natural  pro- 
cesses of  vital  resistance  or  the  life  of  the  patient  is  extin- 
guished. A  careful  review  of  all  the  facts  thus  far  recorded 
shows  clearly  that  the  administration  of  germicides,  anti- 
toxins and  immunizing  agents  has  been  attended  by  a  fair 
degree  of  success  when  they  were  used  during  the  stages  of 
incubation  and  of  initial  febrile  symptoms,  but  with  a  rapidly 
decreasing  efifect  during  the  subsequent  stages  of  the  dis- 
ease. So  true  is  this  that  three-fourths  of  the  life-saving 
influence  attributed  to  the  use  of  anti-diphtheritic  serum  has 
resulted  from  its  administration  during  the  incubative  stage 
and  first  twenty-four  hours  of  fever. 

So  early  as  1860-62,  Dr.  G.  Polli,  of  Milan,  demonstrated 
by  a  reliable  series  of  experiments  that  putrid  and  actively 
poisonous  animal  matter,  injected  into  the  blood  or  tissues 
of  healthy  animals,  could  be  rendered  harmless  by  injecting 
at  the  same  time  efficient  doses  of  hypo-sulphite  of  lime  or 
soda.  From  this  many  inferred  that  the  same  remedies 
might  be  used  successfully  in  the  treatment  of  all  diseases 
caused  by  animal  or  organic  poisons.  Consequently  the 
hypo-sulphites  were  soon  tried  in  all  stages  of  erysipelas, 
smallpox  and  other  eruptive  fevers,  but  with  no  decided  suc- 
cess, except  in  a  very  few  cases  in  which  they  were  given 
during  the  period  of  incubation.  Very  similar  results  fol- 
lowed the  experiments  of  Dr.  Daniel  Brainard,  of  Chicago, 
from  which  he  was  induced  to  propose  the  use  of  iodine  as 
an  antidote  for  the  poison  of  reptiles. 

Indeed,  an  abundant  clinical  experience  has  shown  that 
after  bacteriological  infection  has  fully  developed  in  the 
living  body,  thereby  establishing  active  febrile  phenomena, 
it  is  effectually  neutralized  or  expelled  only  by  the  natural 
processes  of  vital  resistance,  recognized  as  oxidation,  phag- 


i67 

ocytosis,  anti-toxic  evolution  and  excretion.  Therefore  what 
we  now  most  urgently  need  is  more  knowledge  concerning 
these  natural  processes  of  vital  resistance,  and  how  to  aid 
them  in  either  destroying  or  expelling  each  infectious  agent 
after  it  has  multiplied  itself  and  established  the  active  phe- 
nomena of  disease. 

Let  the  clinical  observer  and  the  laboratory  investigator 
unite  in  the  work  of  ascertaining  more  fully  the  changes 
any  given  toxin  or  infectious  agent  produces  in  the  constitu- 
ents of  the  blood,  the  tissues  in  which  it  manifests  a  disposi- 
tion to  accumulate,  the  changes  it  undergoes,  if  any,  by  ox- 
idation, its  efi'ect  on  metabolism,  and  the  excretory  channels 
through  which  it  is  finally  expelled  from  the  living  body. 
Then  will  the  enlightened  practitioner  be  enabled  to  so  ad- 
just the  use  of  his  remedies  during  the  active  progress  of 
disease  as  to  aid  the  natural  processes  and  render  recoveries 
more  certain  and  more  perfect. 

It  was  in  urging  substantially  the  foregoing  views  that 
the  present  writer  closed  the  general  Address  on  Aledicine 
before  the  annual  meeting  of  the  American  Medical  Asso- 
ciation, in  1890,  in  the  following  words : — 

"If  we  would  reach  the  highest  degree  of  success  in  the 
treatment  of  acute  general  diseases,  we  must  keep  distinctly 
in  mind  the  following  propositions  : — 

"i.  We  must  as  early  as  practicable  separate  the  patient 
from  the  further  action  of  both  the  specific  and  the  predis- 
posing causes  of  his  disease  by  surrounding  him  with  pure 
air  and  as  perfect  sanitary  conditions  as  possible ;  and  as  the 
living  animal  system  uniformly  tends  to  either  destroy  or 
eliminate  the  specific  morbific  causes  by  its  own  metabolic 
changes,  we  should  carefully  avoid  the  use  of  such  remedies 
as  either  directly  or  indirectly  retard  or  prevent  such  normal 
metabolic  processes,  even  for  the  repression  of  one  or  more 
prominent  symptoms.  On  the  contrary,  we  must  use  such 
general  alterative  and  antiseptic  remedies  as  are  known  to 
sustain  and  correct  such  processes,  and  thereby  aid  in  hasten- 
ing the  destruction  or  elimination  of  the  disturbing  materies 
morbi,  whether  they  consist  of  living  germs,  chemical  pto- 


i68 

maines  or  leucomaincs,  or  only  excretory  matters  abnormally 
retained  in  the  system. 

"2.  As  the  pyrexia  or  high  temperature  results  mostly 
from  interference  with  the  processes  of  heat  dissipation,  es- 
pecially in  the  ordinary  continued  fevers,  we  must  further 
aid  in  restoring  these  processes  by  gently  promoting  natural 
elimination  and  the  direct  abstraction  of  heat  by  sponge 
baths,  and  in  excessive  cases  by  wrapping  in  the  cold  wet 
sheet,  all  of  which  exert  a  restorative  influence  on  the  vaso- 
motor, cardiac,  and  respiratory  nerve  centres,  while,  with 
equal  care,  we  avoid  administering  such  doses  of  internal 
antipyretics  and  alcoholics  as  diminish  heat  production  by 
retarding  both  blood  and  tissue  metabolism,  and  equally  de- 
press nerve  sensibility  and  force. 

"3.  Again,  as  every  specific  cause  capable  of  producing 
the  complex  assemblage  of  morbid  phenomena  that  consti- 
.tute  a  general  fever,  has  displayed  a  tendency  to  induce  spe- 
cial local  morbid  conditions  in  some  one  or  more  of  the  im- 
portant tissues  or  organs  during  the  progress  of  the  general 
disease,  as  in  the  glands  of  the  ileum,  mesentery  and  spleen 
in  typhoid ;  the  stomach,  duodenum  and  liver  in  periodical 
and  yellow  fevers,  etc.,  we  must  early  and  accurately  use 
such  remedies  as  palliate  or  modify  th^se  local  developments 
wherever  they  may  be  manifested,  and  thereby  prevent  such 
structural  changes  in  these  directions  as  might  otherwise  end 
in  fatal  exhaustion. 

"4.  Finally,  as  all  acute  morbid  processes,  when  estab- 
lished, are  progressive  through  the  successive  stages  of  in- 
crease, culmination  and  decline  or  destruction  of  the  pa- 
tient, we  must  carefully  adjust  both  our  remedial  agents  and 
nutrient  materials  to  the  actual  stage  of  progress  of  the  dis- 
ease and  the  capacity  of  the  patient  to  receive  and  appropri- 
ate the  same ;  ever  remembering  that  the  same  remedial 
agent  that  might  be  of  great  value  in  the  first  stage,  might 
be  injurious  or  even  destructive  if  used  at  the  stage  of  cul- 
mination, or  still  more  in  that  of  decline.  Hence  specific 
remedies  for  acute  general  diseases  can  be  rationally  or  suc- 
cessfully used  only  when  aimed  at  the  destruction  or  elim- 
ination of  the  specific  causes  and  in  the  first  stage  of  the 


169 

morbid  processes.  Indeed,  the  chief  benefits  thus  far  de- 
rived from  the  use  of  antiseptics  and  germicides,  have  been 
as  preventives  in  the  incubative  and  prodromic  stages,  rather 
than  as  curatives  after  active  morbid  processes  have  be- 
come manifest." 

The  zealous  investigators  of  morbid  anatomy  and  patho- 
logical processes  during  the  first  half  of  the  nineteenth  cen- 
tury have  often  been  accused  of  treating  the  diseases  instead 
of  their  patients.  With  equal  propriety  their  successors  who 
emphasize  the  paramoiuit  importance  of  pyrexia  and  heart- 
failure,  may  be  accused  of  treating  symptoms  without  due 
regard  either  to  the  patient  or  his  disease.  And  with  still 
greater  propriety  may  the  profession  of  the  present  time  be 
criticized  for  treating  the  specific  causes  of  diseases  instead 
of  the  patients,  their  pathological  conditions,  or  even  their 
most  important  symptoms.  Is  it  not  possible  to  so.  educate 
the  medical  practitioners  of  the  twentieth  century  that  they 
will  comprehend  more  clearly  the  nature  of  each  depart- 
ment of  medical  knowledge,  and  its  true  relations  to  every 
other  department;  and  thereby  enable  them  to  avoid  the 
partial,  one-sided,  extreme,  and  often  contradictory  practices 
that  have  marred  the  pages  of  all  past  medical  history  ? 

The  all-absorbing  investigations  in  search  for  the  spe- 
cific causes  of  diseases  that  have  characterized  the  last  two 
decades  of  the  nineteenth  century,  have  resulted  in  many 
brilliant  and  important  discoveries  in  the  department  of 
aetiology,  and  have  laid  the  foundation  for  corresponding  im- 
provements in  prophylaxis,  immunity  and  preventive  medi- 
cine. These  have  already  notably  diminished  the  ratio  of 
prevalence  of  several  important  diseases,  and  thereby  added 
to  the  average  duration  of  life. 

But  the  very  common  assumption  that  each  acute  disease 
can  have  but  one  pathogenic  germ  as  a  specific  cause ;  and 
that  when  the  same  disease  or  pathological  condition,  clin- 
ically identical,  is  produced  by  another  germ  it  must  be  re- 
garded as  a  pseudo,  or  false,  disease,  is  neither  justifiable  nor 
in  accordance  with  well  ascertained  facts. 

It  is  well  known  that  from  ten  to  twenty  per  cent,  of 
all  cases  of  well  marked  clinical  diphtheria  exist  without 


170 

the  presence  of  the  Klebs-Loeffler  bacilkis.  So  also  many 
cases  of  pneumonia  occur  and  run  their  course  without  the 
presence  of  the  specific  pneumococcus,  and  cases  of  inflam- 
mation, suppuration,  and  septicaemia  are  recognized  as 
caused  by  several  well  known  pathogenic  bacteria.  There- 
fore, instead  of  multiplying  names  for  the  same  diseases  or 
pathological  conditions  by  making  the  presence  or  absence 
of  some  one  germ  or  toxin  the  sole  diagnostic  test,  it  would 
be  productive  of  far  better  results  if  the  chemico-physiolo- 
gists,  bacteriologists  and  sanitarians  continued  to  recognize 
the  various  well  defined  diseases  as  they  were  clearly  dif- 
ferentiated with  so  much  labor  and  accuracy  by  the  patholo- 
gists and  pathological  anatomists  of  the  first  half  of  the 
century,  and  continued  their  search,  not  for  one  specific 
germ  or  toxin  for  each  disease,  but  for  all  the  germs  or 
toxins  that  may  be  found  connected  with  it  and  their  rela- 
tive importance.  Then  let  them  go  one  step  further  and 
show  how,  by  what  processes,  and  through  what  channels, 
the  germs  or  toxins  already  developed  and  producing  dis- 
ease are  finally  destroyed  or  expelled  from  the  system.  By 
so  doing  they  would  not  only  preserve  the  true  relations  of 
aetiology  to  pathology,  but  also  furnish  us  the  proper  basis 
or  reliable  indications  for  the  rational  treatment  of  the  ac- 
tive stage  of  acute  diseases. 

In  the  meantime,  the  experimental  therapeutists  should 
demonstrate,  by  strictly  scientific  methods,  the  action  of  all 
drugs  and  therapeutic  agents  when  introduced  into  the  liv- 
ing body,  and  the  changes  in  structure  or  function  they  are 
capable  of  producing.  Then  would  the  practitioner  be  able 
to  choose  the  remedies  best  adapted  for  relieving  the  actual 
pathological  conditions  at  each  stage  in  the  progress  of  the 
diseases  he  treats;  and  he  would  be  able  to  so  adjust  them 
as  to  aid  the  natural  processes  of  vital  resistance  in  curing 
diseases. 

Much  has  been  done  in  this  direction  during  the  last  half 
century,  especially  in  regard  to  the  true  action  of  the  nar- 
cotic and  anaesthetic  drugs,  as  detailed  in  the  last  preceding 
chapter.  ]Much,  however,  still  remains  to  be  done.  And 
there  is  much  need  of  applying  the  same  methods  of  inves- 


171 

ligation  for  determining  the  efifects  of  the  habitual  use  of 
all  the  important  articles  of  food  and  drink  and  of  the  va- 
rious occupations  in  modern  life.  For  while  acute  diseases 
may  arise  chiefly  from  bacteriological  and  toxic  agents,  those 
chronic,  slowly-developed,  and  structural  diseases  so  prev- 
alent in  civilized  communities,  have  their  origin  from  mod- 
erate but  frequently  repeated  or  persistdnt>4mpressions  on 
the  organized  elements  of  the  blood  and  on  the  protoplasm 
and  metabolism  of  the  tissues,  by  such  agents  as  tea,  coffee, 
tobacco,  fermented  and  distilled  alcoholic  drinks,  and  other 
anaesthetics,  and  living  or  working  in  close,  ill-ventilated 
rooms,  with  deficient  open  air  exercise.  It  has  already  been 
fully  demonstrated  that  the  habitual  use  of  several  of  these 
agents  cause  impairment  of  the  corpuscular  and  haemoglobin 
elements  of  the  blood,  and  degenerations  of  structure  in  the 
various  tissues  and  organs  of  the  body,  and  thereby  mate- 
riallly  shorten  the  duration  of  life.  And  is  it  not  possible, 
or  even  probable,  that  further  investigations  would  show 
that  the  same  agents,  aided  by  such  modes  of  living  and  oc- 
cupations as  rendered  the  blood  habitually  less  oxygenated 
and  decarbonized  than  natural,  were  capable  of  causing 
morphological  changes  in  some  of  the  non-pathogenic  germs 
that  are  always  found  in  the  human  body,  sufficient  to  con- 
vert them  into  pathogenic  germs  of  great  importance?  If 
the  persistence  of  bad  hygienic  and  sanitary  influences  may 
so  modify  cell  proliferation  as  to  cause  either  morbid 
growths  or  tissue  degenerations ;  or  so  modify  germinal  cells 
as  to  cause  the  transmission  of  hereditary  diseases,  why  not 
the  same  or  similar  influences  change  a  common  colon  bacil- 
lus into  a  typhoid  or  tuberculous  bacillus  ? 

The  whole  field  of  what  has  been  vaguely  termed  pre- 
disposing causes  of  disease,  though  temporarily  neglected  on 
account  of  the  zealous  search  for  specific  causes  and  spe- 
cific remedies,  would  richly  repay  a  thorough  investigation 
and  would  effectually  bring  the  profession  back  to  a  recogni- 
tion of  the  patient  as  well  as  of  his  diseases  and  the  causes 
that  produce  them. 

It  will  be  seen  by  the  foregoing  observations  that  not- 
withstanding the  many  brilliant  discoveries  and  important 


172 

advancements  in  all  departments  of  medicine  and  surgery 
during  the  nineteenth  century,  there  are  still  remaining  am- 
ple fields  in  which  the  investigators  of  the  twentieth  centur}' 
ma}'  gain  equal  renown  and  the  human  race  even  greater 
benefits.  And  it  would  render  such  a  result  much  more  cer- 
tain if  a  study  of  medical  history  were  added  to  the  curric- 
ulum of  every  medical  school.  For,  in  the  language  of 
Hippocrates,  "the  physician  must  know  what  others  have 
known  or  he  is  constantly  liable  to  deceive  both  himself  and 
others."  The  very  general  neglect  of  this,  especially  during 
the  last  three  centuries,  has  caused  the  education  of  each 
generation  of  medical  men  to  be  limited  almost  entirely  to 
the  popular  views  and  practices  of  their  own  time,  without 
any  adequate  knowledge  of  those  entertained  and  practised 
by  their  predecessors. 

This  has  led  to  the  unnecessary  duplication  of  work  in 
many  directions ;  to  the  complaisant  exaggeration  of  the  im- 
portance of  present  discoveries  and  practices  compared  with 
those  of  preceding  periods ;  and  to  the  very  imperfect  per- 
ception of  the  inter-dependence  of  medical  advancements  in 
all  ages  with  the  coincident  advancements  in  all  other  nat- 
ural and  physical  sciences. 


173 


CHAPTER  XIII. 

MEDICAL  EXCRESCENCES  OR  BRIEF  NOTICES  OF  THE  MORE  IN- 
FLUENTIAL MEDICAL  SECTARIAN  DOGMAS  THAT  HAVE  AT- 
'TRACTED  MORE  OR  LESS  PUBLIC  ATTENTION  DURING  THE 
EIGHTEENTH  AND  NINETEENTH  CENTURIES.  THE  ORIGIN 
OF  SO-CALLED  '^SCHOOLS  OF  MEDICINE"— HOMEOPATHY ; 
THOMSONIANISM  ;  BOTANICO-MEDICAL ;  ECLECTICISM/ 
CHRISTIAN   science;  OSTEOPATHY,  ETC. 

In  the  preceding  chapter  was  completed  a  brief  history  of 
the  origin,  development  and  progress  of  the  science  and  art 
of  medicine  and  its  relations  to  the  progress  of  all  other 
sciences   or  departments   of  human  knowledge,   from   the 
earliest  medical  records  to  the  close  of  the  nineteenth  cen- 
tury.   Such  history  has  shown  that  prior  to  the  actual  study 
of  human  anatomy,  and  the  development  of  analytical  chem- 
istry during  the  fourteenth  and  fifteenth  centuries,  A.  D., 
all  medical  practice  was  essentially  empirical,  though  often 
modified  in  application  by  the  prevailing  systems  of  so-called 
philosophy.  And  as  nearly  all  the  more  eminent  philosophers 
of  the  earlier  centuries  were  also  physicians,  each  attracting 
to  himself  or  his  doctrines  more  or  less  numerous  followers 
or  disciples  who  regarded  him  as  the  founder  of  a  system 
or  school  of  medicine  which  they  designated  by  his  name. 
Thus  before  the  Christian  era  we  had  prominently  the  med- 
ical schools  of  Hippocrates;  Plato;  Aristotle;  Asclepiades, 
and  Soranus ;  and  during  the  ten  subsequent  centuries,  the 
schools  of  Galen ;  Cselius  Aurelianus ;  ^tius ;  Alexander  of 
Tralles;  Paulus  of  ^gina;  and  in  Arabia,  the  school  of 
Rhazes,  Avicenna  and  Geber.     Each  of  these  schools  con- 
sisted of  the  observed  facts,  opinions  and  theoretical  views 
of  the  individual  teacher  or  writer  and  his  followers.    All  of 
them  embraced  some  items  of  value,  and  all  of  them  were 
more  or  less  influenced  by  the  universal  belief  in  the  ele- 
mentary nature  of  fire,  air,  earth,  and  water,  and  in  the  four 
humors  and  their  concoctions. 

Pre-eminent  amiong  all  these  early  leaders  in  medicine 


174 

were  Hippocrates  and  Galen,  whose  wide  fields  for  obser- 
vation, close  adherence  to  observed  facts  and  the  results  of 
experience  in  the  treatment  of  diseases,  gave  to  their  writ- 
ings unquestioned  authority  both  as  text-books  and  guides 
in  practice  for  more  than  one  thousand  years. 

The  development  of  human  anatomy  by  A''esalius  and  of 
analytical  chemistry  by  the  alchemists  during  the  fourteenth 
and  fifteenth  centuries,  aided  by  the  invention  of  the  art  of 
printing,  struck  the  first  effectual  blow  against  the  reign 
of  personal  authority,  and  laid  the  chief  corner  stone  for  the 
whole  fabric  of  true  medical  science  and  practice,  as  briefly 
indicated  in  the  preceding  chapters  of  this  volume.  Once 
in  possession  of  a  correct  knowledge  of  all  parts  of  the 
human  body  constituting  descriptive  anatomy,  the  study  of 
the  function  of  each  part  necessarily  followed,  thereby  de- 
veloping the  department  of  Physiology. 

As  all  diseases  are  departures  from  physiological  condi- 
tions of  function  or  structure,  or  of  both,  the  study  of  such 
conditions  soon  added  to  the  expanding  field  of  medical 
knowledge  the  departments  of  Pathology,  Pathological  An- 
atomy and  Physical  Diagnosis.  During  the  same  time  the 
application  of  analytical  chemical  processes  to  the  study  of 
air,  earth,  water  and  inorganic  bodies  generally,  rapidly 
revealed  their  actual  composition,  the  laws  governing  their 
combination,  and  the  physical  forces  by  which  they  were  in- 
fluenced, as  affinity,  attraction,  heat,  light  and  electricity. 
Extension  of  the  same  analytical  processes  to  the  study  of 
organic  bodies  soon  revealed  the  composition  of  .  living 
bodies,  both  vegetable  and  animal,  by  which  has  been  devel- 
oped the  extensive  departments  of  physics  and  biology.  And 
as  the  progress  of  physics  brought  to  our  aid  the  microscope, 
by  the  persistent  and  skillful  use  of  which  every  department 
of  medicine  has  been  enriched  or  renovated  and  the  impor- 
tant fields  of  ■  minute  anatomy  and  bacteriology  have  been 
added,  the  co-incident  discovery  of  the  art  of  printing  not 
only  furnished  the  needed  facilities  for  recording  and  pre- 
serving the  facts  and  results  of  investigations  of  every 
kind,  but  by  the  publication  of  papers  and  periodicals  fur- 
nished the  first  efiicient  medium  for  free  discussion,  and  the 


175 

rapid  diffusion  of  knowledge  in  all  the  countries  of  Christen- 
dom. 

By  the  co-operation  of  these  several  influences,  during 
the  sixteenth,  seventeenth  and  eighteenth  centuries,  not  only 
was  medicine  transformed  from  an  aggregation  of  fanciful 
closet  speculations  and  the  facts  of  individual  experience,  but 
it,  together  with  all  the  departments  of  natural  science  were 
developed  by  strictly  scientific  investigations  and  logical  de- 
ductions from  carefully  observed  facts.  Consequently,  dur- 
ing the  nineteenth  century  it  became  impossible  longer  to 
build  up  or  maintain  any  purely  theoretical  or  exclusive  in- 
dividual schools  of  medicine,  founded  on  some  one  supposed 
universal  law  of  disease  or  equally  universal  law  of  cure, 
within  the  ranks  of  educated  medical  men.  Many  such  at- 
tempts have  been  made.  But  the  strictly  scientific  investiga- 
tions, clinical  experience,  and  free  discussions  to  which  they 
were  subjected  soon  caused  them  to  be  either  abandoned  or 
compelled  to  withdraw  from  the  legitimate  channels  of  med- 
ical discussion,  and  appeal  to  the  non-professional  public 
through  the  ordinary  newspapers  or  to  periodicals  devoted 
exclusively  to  the  advocacy  of  their  special  dogmas.  By 
such  means  the  idea  of  the  existence  of  several  distinct  and 
rival  Schools  of  Medicine  has  been  perpetuated  in  the  pop- 
ular mind,  and  are  recognized  in  the  laws  of  many  of  our 
States  until  the  present  time. 

The  most  noted  of  these  is  the  Homeopathic  school, 
founded  by  Hahnemann  during  the  last  quarter  of  the  eight- 
eenth century.  Samuel  Christian  Friedrich  Hahnemann,  of 
Germany,  was  born  in  1755,  A.  D.,  and  died  in  1843.  He 
commenced  the  study  of  medicine  in  1775  at  Leipsic  and 
after  two  years  changed  to  Vienna,  where  he  was  obliged  to 
spend  a  part  of  his  time  in  earning  the  money  necessary  for 
prosecuting  his  studies.  He  graduated  at  Erlangen  in  1779. 
During  the  next  twenty-five  years  he  resided  and  practised 
his  profession  in  no  less  than  twelve  different  cities  of  Ger- 
many. 

In  1792  he  was  Superintendent  of  the  Asylum  for  the 
Insane  at  Georgenthal,  in  Thuringia,  and  in  1794  he  was  in 
Pyrmont  and  Brunswick.    While  at  Leipsic  he  devoted  con- 


1/6 

siderable  attention  to  chemistry  and  materia  medica,  and  it 
is  said  was  requested  to  test  the  effects  of  cinchona  upon 
himself  by  CuUen,  While  taking  moderate  doses  of  cin- 
chona for  this  purpose  he  claimed  that  it  caused  chills  and 
fever  closely  resembling  the  symptoms  of  intermittent  fever 
for  which  it  had  come  to  be  regarded  as  the  chief  remedy. 
This  directly  suggested  the  theory  that  the  most  appropriate 
and  effectual  remedy  for  any  disease  was  the  one  that  when 
given  in  health  produced  symptoms  most  resembling  those 
of  the  disease  it  was  capable  of  curing.  Hence  his  maxim 
"Similia  Similibus  Curantur",  which  is  said  to  have  been 
vaguely  hinted  at  by  Hippocrates  and  more  plainly  stated  by 
Paracelsus.  He  soon  began  to  apply  his  theory  in  his  prac- 
tice by  administering  moderate  doses  of  several  important 
drugs  either  to  himself  or  other  persons  in  good  health,  and 
recording  minutely  all  the  sensations  or  symptoms  that  fol- 
lowed the  taking  of  each  dose  not  only  during  the  succeed- 
ing few  hours,  but  for  several  days.  With  the  aid  of  his 
friends,  a  Materia  ^Medica  was  soon  constructed  consisting 
of  the  proved  symptoms  of  each  drug.  In  like  manner  dis- 
eases were  studied  and  their  symptoms  only  recorded  in  de- 
tail. Consequently  all  the  physician  had  to  do  when  called 
to  a  patient  was  to  note  his  symptoms  carefully  and  then 
select  as  the  proper  remedy  the  drug  with  symptoms  most 
closely  resembling  those  presented  by  the  patient. 

Questions  pertaining  to  aetiology,  pathology  and  patho- 
logical anatomy  received  little  or  no  attention ;  the  system 
being  founded  exclusively  on  symptomatology.  Any  one 
of  its  most  remarkable  features  was  the  number  of  symp- 
toms attributed  to  a  single  dose  of  each  drug.  For  ex- 
ample, to  chloride  of  sodium  were  attributed  1349  symp- 
toms; to  lycopodium,  1608;  and  to  some  of  the  more  impor- 
tant drugs  the  number  of  symptoms  enumerated  was  over 
4,000. 

In  1796  Hahnemann  published  an  "Essay  on  a  New 
Principle  for  Ascertaining  the  Curative  Properties  of 
Drugs"  in  which  he  not  only  advocated  his  law  of  similia 
similibus  as  the  tmiversal  law  of  cure,  but  also  the  doctrine 
that  by  certain  dilutions  and  attenuations  the  curative  power 


177 

of  drugs  could  be  increased  to  an  unlimited  degree.  By  these 
processes  was  evolved  his  second  universal  law,  i.  e.,  the 
greater  the  attenuation  of  a  drug,  or  the  smaller  the  dose,  the 
greater  the  curative  power. 

He  also  attached  much  importance  to  the  method  and  de- 
gree of  attenuating  or  diluting  medicines  for  use.  If  the 
crude  drug  was  in  liquid  form,  one  minim  was  to  be  put 
with  one  hundred  minims  of  water  or  alcohol  and  given  a 
certain  number  of  shakes,  which  constituted  the  first  dilu- 
tion. One  minim  of  this  was  to  be  mixed  with  one  hundred 
minims  of  water  for  the  second  dilution.  The  same  process 
was  repeated  until  the  tenth,  twentieth  or  even  thirtieth  di- 
lution was  reached.  It  was  claimed  that  each  dilution  im- 
parted additional  potency  or  curative  power;  and  the  thir- 
tieth, which  would  contain  only  an  infinitesimal  part  of  a 
minim  of  the  drug  was  regarded  by  Hahnemann  as  the  most 
important  for  use  in  the  treatment  of  acute  diseases.  If 
the  crude  drug  was  in  the  form  of  powder  the  same  prin- 
ciple governed  in  its  preparation  for  use.  One  grain  was 
triturated  with  one  hundred  grains  of  sugar  of  milk  for  the 
first  attenuation.  One  grain  of  this  was  triturated  with  an- 
other one  hundred  grains  of  sugar  of  milk,  and  so  on  to  the 
tenth,  twentieth  or  thirtieth  attenuation  and  then  generally 
rolled  into  small  pellets  or  pills. 

The  publication  of  this  law  of  increased  potency  in  direct 
proportion  to  the  degree  of  attenuation,  or  smallness  of  the 
dose,  was  received  with  so  much  skepticism  and  derision  by 
the  profession,  that  in  1802  he  abandoned  the  regular  med- 
ical channels  of  communication,  and  began  to  address  his 
views  to  the  public,  both  by  public  lectures  and  through  the 
secular  press.  In  1805  while  at  Torgau  he  first  styled  his 
own  system  founded  on  the  laws  of  similars  and  infinitesimal 
doses  as  Homeopathy,  and  all  other  medical  practice  as  Allo- 
pathy. His  leading  work  called  "The  Organon"  was  pub- 
lished in  1810.  The  next  year  he  settled  in  Leipsic,  where 
he  lectured  and  practised  and  succeeded  in  gaining  some 
medical  converts,  among  whom  were  Gross,  Hornburg,  and 
Wislicanus.  As  both  Hahnemann  and  his  followers  pre- 
pared their  own  medicines,  which  brought  them  in  conflict 


178 

with  the  apothecaries,  the  authorities  of  Saxony  were  in- 
duced to  forbid  medical  practitioners  to  prepare  or  dispense 
their  own  medicines.  This  caused  him  to  change  his  resi- 
dence to  Kothen  in  1821,  where  he  became  physician-in-or- 
dinary to  the  Lord  of  Anhalt-Kothen  and  where  his  wife 
died  in  1825.  ^^'hile  at  Kothen  he  and  his  followers  began 
to  organize  Homeopathic  societies,  journals  and  hospitals ; 
and  in  1828  he  published  his  work  on  Chronic  Diseases,  in 
which  he  contended  that  all  such  diseases  were  caused  either 
by  syphilis,  sycosis  or  psora  (itch). 

In  1830  he  married  a  young  French  woman  who  was 
possessed  of  an  ample  fortune  and  by  whom  he  was  soon 
persuaded  to  settle  in  Pans,  where  he  continued  his  practice 
and  attracted  much  public  attention  until  his  death  in  1843. 
His  fundamental  doctrine  concerning  the  nature  of  diseases 
was  that  they  were  "spirit-like,  or  dynamic  aberrations  of 
our  spirit  life  manifested  in  sensations  and  actions."  He  ad- 
mitted no  morbid  anatomy,  no  material  causes  of  disease,  and 
made  no  classification,  except  into  acute  and  chronic.  He 
admitted  of  but  one  law  of  cure,  i.  e.,  similia  similibus,  and 
but  one  mode  of  creating  specific  remedies,  i.  e.,  by  the 
potentizing  effects  of  repeated  attenuations  or  dilutions. 

His  earlier  disciples,  Hermann,  Gross  and  Lutz  soon 
carried  his  law  of  similars  to  the  extreme  of  actual  Isopathy, 
by  attempting  to  cure  variola  by  administering  variolus  pus ; 
diarrhoea  by  giving  f^cal  matter;  tapeworm  by  eating  joints 
or  segments  of  the  worm.  This,  however,  was  too  disgust- 
ing to  attract  many  followers.  On  the  other  hand,  the  later 
and  better  educated  followers  of  Hahnemann,  as  early  as 
1850,  began  to  recognize  and  incorporate  into  their  teaching 
the  results  of  pathological  investigations,  and  to  use  in  their 
practice  larger  doses  of  medicine.  They  admitted  that  some 
medicines  acted  on  particular  organs  or  tissues.  Such  was 
the  case  particularly  with  Griessellich,  Arnold  and  Herschel. 

In  1 87 1  Heinigke  endeavored  to  explain  the  potentizing 
of  drugs  by  claiming  that  by  the  numerous  dilutions  or  tritu- 
rations the  atoms  of  the  drugs  were  freed  from  their  chem- 
ical affinities,  and  only  by  such  molecular  freedom  did  they 
acquire  specific  curative  power  in  the  treatment  of  diseases. 


179 

Lutze,  in  his  memorial  address  on  Hahnemann  in  1872,  said  : 
"The  poisonous  properties  are  removed  from  a  drug  through 
its  dilutions,  while  its  special  peculiarities,  so  to  speak,  its 
soul,  remained  and  by  rubbing  and  shaking  becomes  vivified 
and  strengthened  by  human  magnetism." 

The  system  of  practice  of  Hahnemann  was  introduced 
into  England  by  a  Dr.  Ouin,  in  1827,  and  gained  some  atten- 
tion and  patrons  chiefly  in  the  larger  cities.  One  hospital 
containing  100  beds  was  established  in  London,  in  connection 
with  which  was  organized  the  only  homeopathic  college  in 
Great  Britain. 

The  system  was  introduced  into  the  United  States  by 
Dr.  Hans  B.  Gram,  a  native  of  Boston,  but  who  had  been  ed- 
ucated in  Copenhagen  and  returned  to  this  country  in  1825, 
settHi^  in.  the  City  of  New  York  where  he  practised  until 
his  death  in  1840. 

The  novelty  of  the  soMalled  law  of  cure  by  similars, 
coupled  with  the  mystery  of  potentizing  drugs  by  dilution 
until  they  became  tasteless  and  infinitesimal  in  dose,  and  dis- 
eases claimed  to  be  only  "dynamic  aberrations  of  our  spirit 
life",  were  well  calculated  to  attract  the  attention  of  a  few 
medical  men  and  a  large  class  of  non-professional  reading 
persons  of  both  sexes  who,  so  far  as  relates  to  medicine,  are 
prone  to  place  the  most  implicit  faith  in  whatever  of  theory 
or  practice  is  most  mysterious  or  incomprehensible.  Conse- 
quently the  doctrines  of  Hahnemann  were  embraced  by  a 
sufficient  number  of  medical  men,  chiefly  in  the  larger  cities 
of  this  country,  to  enable  them  to  commence  the  publication, 
in  1834,  of  a  journal  called  the  "American  Journal  of  Hom- 
eopathia",  edited  by  Drs.  J.  F.  Gray  and  A.  Gerald  Hull; 
and  in  1844  they  organized  the  "American  Institute  of 
Homeopathy"  with  between  forty  and  fifty  members. 

One  of  the  most  active  propagators  of  the  homeopathic 
doctrines  in  this  country  was  Constantin  Hering,  a  native 
of  Saxony,  who  cam.e  to  the  United  States  in  1834.  He  was 
the  author  of  the  work  called  the  "Domestic  Physician",  pub- 
lished in  1858,  which  in  connection  with  neatly  filled  cases 
of  ready  prepared  attenuated  medicines  in  the  form  of  sugar 


i8o 

"pellets",  greatly  facilitated  the  introduction  of  the  system 
into  family  use. 

During  the  three  decades  following  1840  the  converts  to 
the  system  increased  with  considerable  rapidity.  Homeo- 
pathic societies  were  organized  in  a  majority  of  the  States. 
Homeopathic  hospitals,  colleges  and  journals  were  estab- 
lished in  several  of  the  large  cities,  and  the  system  reached 
the  climax  of  its  popularity  before  the  end  of  the  third  quar- 
ter of  the  nineteenth  century,  when  it  claimed  the  existence 
of  12  or  13  colleges  from  which  about  430  persons 
were  graduated  annually,  while  the  regular  medical  col- 
leges numbered  124  and  the  annual  number  of  graduates 
more  than  3,000.  Even  this  very  limited  degree  of  develop- 
ment from  an  hundred  years  of  strictly  sectarian  cultivation 
has  been  attained  only  by  the  practical  abandonment  of  every 
distinctive  principle  or  doctrine  advocated  by  Hahnemann, 
except  the  names  he  invented,  i.  e.,  Homeopathy  and  Allo- 
pathy. By  following  the  example  of  Griesselich,  Arnold  and 
Herschel,  and  incorporating  into  their  works  the  results  of 
the  regular  investigations  in  pathology,  pathological  anatomy, 
aetiology,  bacteriology  and  diagnosis ;  and  into  their  schools 
the  same  text-books  on  two  thirds  of  the  branches  taught 
as  are  used  in  all  the  regular  medical  schools;  and  in  their 
practice  the  use  of  drugs  in  any  doses  required  to  produce  the 
desired  effect,  they  have  preserved  before  the  public  the 
form  and  machinery  of  a  medical  sect  called  Homeopathic, 
while  the  fanciful  dogmas  of  its  founder  have  practically 
disappeared.  And  there  are  abundant  evidences  indicating 
that  before  the  middle  of  the  twentieth  century  even  the 
name  will  have  become  as  obsolete  as  the  fanciful  dogmas 
it  was  invented  to  designate.  The  Medical  Times,  formerly 
an  influential  homeopathic  journal,  recently  made  the  follow- 
ing statement :  "The  American  Homeopathist  has  changed 
its  name  to  the  American  Physician ;  and  it  is  a  most  sensible 
thing  to  do.  The  use  of  the  terms  homeopathic  and  allo- 
pathic is  obsolete,  and  it  would  be  better  if  they  were  never 
used." 

Thompsonianism  :  While  homeopathy,  or  the  system  of 
Hahnemann,  was  having  its  birth  and  development  in  Ger- 


i8i 

many  an  equally  -fanciful,  though  far  more  dangerous,  sys- 
tem of  medicine  was  conceived  and  promulgated  in  this  coun- 
try by  Benjamin  Thompson,  who  was  born  in  New  Hamp- 
shire in  1769  and  died  in  Boston  in  1843.  With  a  very  lim- 
ited degree  of  education  in  either  literature,  science  or  medi- 
cine he  promulgated  through  the  secular  press  a  system  of 
medicine  and  commenced  prescribing  for  the  sick  in  1792. 
His  system  and  practice  were  based  on  the  following  declara- 
tions :  "Heat  is  life.  Cold  is  death.  Vegetables  grow  up- 
ward and  sustain  life.  Minerals  sink  in  the  earth  and  there- 
fore tend  to  produce  death."  Consequently  he  selected  all 
his  remedies  from  the  vegetable  kingdom  with  the  exception 
of  hot  water  or  steam. 

As  his  knowledge  of  botany  was  very  limited  his  list  of 
remedies  was  equally  brief,  consisting  of  lobelia  inflata, 
steam,  cayenne  pepper  and  a  strong  tincture  of  pungent  aro- 
matic herbs  called  "No.  6",  all  chosen  for  their  supposed 
influence  in  sustaining  the  temperature  of  the  living  body, 
and  increasing  the  evacuation  of  all  morbid  or  disease-pro- 
ducing agents  through  the  stomach  by  emesis,  and  the  skin 
by  diaphoresis.  He  discarded  the  use  of  all  mineral  medi- 
cines, and  was  especially  severe  in  denouncing  the  prepara- 
tions of  mercury,  and  all  physicians  who  prescribed  them. 
He  attributed  all  cases  of  necrosis,  chronic  rheumatism, 
periostitis,  and  neuralgia  to  the  poisonous  effects  of  calomel 
and  other  minerals  previously  given  by  regular  physicians. 
His  usual  mode  of  treating  all  acute  diseases  was  to  produce 
free  vomiting  by  full  doses  of  lobelia,  followed  by  steam  or 
vapor  baths,  and  then  frequent  doses  of  cayenne  pepper  or 
of  "Number  6".  Even  many  old  chronic  diseases  were 
treated  by  the  same  active  routine  for  the  purpose  of  ex- 
pelling from  the  system  mineral  poisons  alleged  to  have  been 
taken  years  previously. 

Thompson  prepared  and  had  printed  a  small  book  stat- 
ing his  fundamental  doctrines  and  method  of  treating  dis- 
eases and  in  1813  obtained  a  patent  on  his  system,  and  be- 
gan to  sell  to  other  parties  the  right  to  practise  it,  with  a 
copy  of  his  book,  for  $20.  A  travelling  agent  for  the  Ohio 
Valley  and  Southern  States  is  reported  to  have  sold  no  less 


I«2 


than  4,000  copies  between  1827-30,  thereby  realizing  $80,- 
000.  The  simplicity  of  Thompson's  theories  and  the  visible 
activity  of  his  remedies,  coupled  with  the  constant  denun- 
ciation of  the  regular  profession  for  using  poisonous  min- 
erals, caused  them  to  be  readily  adopted  by  the  less  edu- 
cated and  working  classes  in  all  parts  of  the  country.  A  very 
large  majority  of  those  who  chose  to  practise  the  Thomp- 
sonian  system  were  devoid  of  any  regular  medical  education 
or  legal  license  to  practise,  and  were  very  generally  styled 
"steam  and  herb  doctors."  Their  ignorant  and  reckless  ad- 
ministration of  repeated  emetic  doses  of  lobelia  and  pro- 
tracted vapor  baths  produced  fatal  exhaustion  in  many  cases, 
even  in  the  care  of  Thompson  himself,  by  which  he  became 
involved  in  several  suits  for  malpractice  and  lost  much  of  his 
earlier  influence,  before  his  death  in  1843. 

As  the  personal  influence  of  Thompson  passed  its  zenith. 
Dr.  Alva  Curtis,  of  Ohio,  became  a  leader  with  more  knowl- 
edge of  medical  botany  and  more  caution  in  the  use  of  lo- 
belia and  steam,  and  introduced  among  his  followers  a  larger 
number  of  vegetable  remedies,  but  maintained  all  the  bitter- 
ness of  the  original  Thompsonians  against  the  use  of  min- 
erals. 

He  designated  his  system  as  Botanico-AIedical,  and  in 
1837  commenced  the  publication  of  a  journal  advocating  it 
in  Columbus ;  and  in  1841  he  obtained  a  charter  for  a  Botan- 
ico-Medical  college  to  be  established  in  Cincinnati.  Later 
he  professed  to  discard  the  use  of  all  poisons  as  medicines 
whether  mineral  or  vegetable,  claiming  that  all  remedies  to 
exert  a  curative  influence  must  act  in  harmony  with  physio- 
logical processes,  and  therefore  changed  the  name  of  his  sys- 
tem to  "Physio-Medical"  instead  of  Botanico-Medical. 

He  succeeded  in  attracting  some  followers  until  1855 
when  his  journal,  called  the  Physio-Medical  Recorder,  passed 
under  the  control  of  Dr.  W.  H.  Cook,  who  continued  its  pub- 
lication until  1885  when  both  it  and  the  college  in  Cincinnati 
were  discontinued.  In  the  meantime  a  Physio-Medical  col- 
lege had  been  organized  in  Indianapolis  and  another  in  Chi- 
cago, from  which  about  twenty  students  were  graduated 
annually  from  1881  to  1890.    Since  the  latter  date  the  num- 


i83 

ber  of  students  in  attendance  has  seldom  equalled  the  num- 
ber of  their  professors. 

While  Dr.  Curtis  was  leading  one  part  of  the  original 
followers  of  Thompsonianism  in  the  direction  of  the  Physio- 
Medical  system,  Dr.  Wooster  Beach  was  leading  the  re- 
mainder in  the  direction  of  simple  Eclecticism  by  endeavor- 
ing to  establish  a  "Reformed  Medical  College"  in  New  York. 
Failing  in  that,  another  college  was  organized  at  Worthing- 
ton,  Ohio,  and  attracted  a  few  students  annually  for  ten 
years  when  it  ceased  to  exist.  In  1845  a  much  more  suc- 
cessful institution  was  established  in  Cincinnati,  Ohio,  called 
the  "Eclectic  Medical  Institute."  Dr.  John  M.  Scudder  be- 
came professor  of  Practice  and  Pathology;  and  Drs.  J.  B. 
Jones,  William  Sherwood  and  John  King  were  also  mem- 
bers of  the  faculty.  Dr.  Scudder  added  to  his  eclectic  princi- 
ple of  selecting  the  good  from  all  other  systems  of  practice 
that  of  "specific  medication."  Drs.  Jones  and  Sherwood 
published  a  work  entitled  "American  Eclectic  Practice  of 
Medicine"  in  1857  '>  and  Dr.  King  a  work  on  "Chronic  Dis- 
eases" in  1867,  and  an  "American  Dispensatory"  in  1874. 

The  Eclectic  Institute  in  Cincinnati  thus  became  the  lead- 
ing college  of  Eclecticism  in  America,  and  during  the  first 
twenty  years  of  its  existence  graduated  not  less  than  1800 
students. 

Other  Eclectic  schools  and  journals  were  established  in 
many  of  the  larger  cities,  and  Eclectic  Medical  Societies  were 
organized  in  a  majority  of  the  states  prior  to  1880.  Since 
that  date,  more  than  half  of  the  schools  and  journals  orig- 
inally established  have  been  discontinued  for  lack  of  sup- 
port, and  the  sect  appears  to  be  in  the  same  state  of  decline 
as  the  Physio-Medicists.  Yet  during  the  most  active  and  ag- 
gressive stage  in  the  progress  of  both  Eclecticism  and  Home- 
opathy, which  was  during  the  second  quarter  of  the  nine- 
teenth century,  they  were  enabled  to  induce  the  legislatures 
of  several  states  to  repeal  the  legal  restrictions  that  had  been 
enacted  against  unlicensed  practitioners.  And  chiefly  by  the 
direct  political  influence  of  their  state  society  organizations 
they  have  succeeded  in  causing  their  legal  recognition  by 
representation  on  nearly  all  the  State  Boards  of  Health  and 


i84 

Examination  in  the  several  states,  thus  presenting  the  ab- 
surd position  of  legally  recognizing  several  distinct  and  op- 
posing medical  theories,  and  thereby  perpetuating  the  er- 
roneous popular  idea  of  competing  schools  of  medicine. 

The  true  object  of  establishing  State  Boards  of  Exam- 
iners is,  or  should  be,  to  see  that  all  persons  licensed  to  prac- 
tise medicine  were  possessed  of  sufficient  knowledge  of  all 
the  branches  of  medical  science  and  theory  to  make  them 
safe  practitioners  of  *he  healing  art.  Neither  the  Home- 
opathic, Thompsonian,  Botanico-AIedical,  nor  modem  Ec- 
lectic, so-called,  systems  or  schools  of  medicine  have  re- 
ceived legal  recognition  in  any  of  the  countries  of  Europe. 

Now,  with  the  close  of  the  nineteenth  century,  the  most 
popular  and  progressive  medical  sectarians  are  the  "Chris- 
tian Scientists",  the  "faith"  or  "Divine  Healers",  and  the 
"Osteopaths",  all  of  whom  discard  entirely  the  use  of  medi- 
cine. The  two  first  rely  entirely  on  mental  influences  for 
the  relief  of  human  suffering,  and  the  third  add  a  vigorous 
system  of  massage  ostensibly  for  correcting  displacements 
and  imperfect  adjustments  of  the  bones  in  the  living  body, 
to  which  they  attribute  all  forms  of  disease. 

The  Christian  Scientists,  who  are  the  most  numerous  and 
most  active  in  winning  followers  on  both  sides  of  the  At- 
lantic, declare  all  diseases  and  sufferings  to  be  only  morbid 
mental  conditions,  to  be  removed  solely  by  persuading  them- 
selves that  they  are  well,  aided  by  the  mental  suggestions  and 
will  power  of  others.  The  founder  of  the  sect,  IMrs.  Baker 
Eddy,  of  jMassacliusetts,  claims  to  have  discovered  the  true 
method  of  curing  diseases  by  her  own  spontaneous  recovery 
from  the  effects  of  an  internal  injury  caused  by  an  accident. 
She  first  called  her  system  "Divine  IMetaphysical  Healing." 
In  1866  she  changed  the  name  to  "Christian  Science" ;  and  in 
1876  organized  in  Boston  the  first  Christian  Science  Society. 
Since  that  time  her  followers  have  increased  with  consider- 
able rapidity,  and  Christian  Science  societies,  churches  and 
schools  have  been  formed  in  many  parts  of  this  country,  and 
to  some  extent  in  Europe.  The  system  as  taught  and  pub- 
lished by  Airs.  Eddy  is  a  blending  or  union  of  her  ideas  of 
religion  and  medicine  as  complete  as  was  the  religio-medical 


i85 

doctrines  of  the  ^sclepiadae  of  ancient  Greece  and  Rome. 
It  claims  that  all  suffering  or  disease  is  mental,  and  to  be 
cured  only  by  mental  influences.  The  use  of  drugs  or  ma- 
terial medicines  of  every  kind  is  persistently  refused.  The 
patient  or  sufferer  is  given  the  most  positive  assurances  that 
if  he  will  persistently  endeavor  to  believe  that  he  has  no 
bodily  or  physical  disease,  and  will  devote  a  specified  time 
each  day  to  such  efforts,  and  at  the  same  hours  have  the  aid 
of  the  will  power  and  suggestion  of  one  or  more  of  those 
who  have  acquired  confidence  and  skill  in  guiding  the  mental 
forces,  he  will  find  relief.  Every  intelligent  reader  will  per- 
ceive that  this  "Christian  Science"  is  simply  an  effort  to  re- 
lieve all  suffering  by  hypnotism  and  mental  suggestion  as 
recognized  by  regular  physicians  and  psychologists,  with 
enough  reference  to  Divine  aid  to  justify  calling  it  Chris- 
tian. 

From  the  preceding  brief  history  of  the  more  noted  spe- 
cial or  exclusive  schools  of  Medicine  existing  during  the 
nineteenth  century,  it  will  be  seen  that  the  founders  of  each 
voluntarily  withdrew  with  their  followers  from  the  ordinary 
medical  periodicals  and  channels  for  professional  discus- 
sion, and  proclaimed  their  doctrines  through  either  period- 
icals exclusively  for  that  purpose  or  through  the  secular 
press.  They  all  claimed  to  have  discovered  some  one  uni- 
versal law  of  morbid  action  or  disease,  and  one  general  ther- 
apeutic law  of  cure,  on  which  their  respective  systems  were 
based,  with  little  or  no  reference  to  progressive  pathological 
changes  or  the  material  causes  of  disease.  Consequently 
they  were  incapable  of  improvement  by  the  application  of 
new  discoveries  in  either  physics  or  biology ;  and  equally  in- 
capable of  furnishing  a  basis  for  preventive  medicine  or  pub- 
lic sanitation,  without  ignoring  or  nullifying  one  or  more  of 
their  fundamental  laws,  and  at  every  step  approximating  the 
scientific  field  of  legitimate  medicine,  until  having  only  the 
sectarian  name  left  for  a  proprietary  trademark. 

Such  has  been  the  fate  of  all  attempts  to  establish  sec- 
tarian schools  of  medicine  or  special  medical  systems,  founded 
on  some  one  or  more  so-called  universal  laws,  either  of  aetiol- 
ogy, pathology,  or  therapeutics,  through  all  the  centuries 


i86 

past,  and  such  will  be  their  fate  to  the  end  of  time,  for  the 
simple  reason  that  there  are  no  such  universal  laws  govern- 
ing the  development  and  progress  of  disease,  or  of  its  cure. 
Man,  as  a  living  being,  is  subject  to  all  the  influences,  men- 
tal and  physical,  that  surround  him  in  the  air,  the  water,  the 
earth,  the  ingesta  of  food  and  drink,  and  the  social  condi- 
tions he  encounters.  And  his  diseases  are  as  diverse  in  their 
origin,  progress  and  results  as  are  the  ever  varying  condi- 
tions that  surround  him.  Consequently  the  several  depart- 
ments of  legitimate  medicine  are  composed  of  such  facts  and 
materials,  gathered  from  every  other  field  of  human  knowl- 
edge, as  relate  to  the  causes,  tendencies  and  results  of  dis- 
eases, and  their  remedies.  Each  of  those  departments,  there- 
fore, must  advance  with  every  new  discovery  or  advance- 
ment or  implement  of  more  accurate  research,  in  the  general 
departments  of  science  to  which  they  relate.  Such  are  the 
diverse  tendencies  and  results  of  legitimate  medicine,  and  of 
medicine  founded  on  exclusive  dogmas  or  so-called  universal 
laws.  The  one  is  ever  progressive,  the  other  like  the  good 
ship  stranded  upon  the  rocks. 


i87 


CHAPTER  XIV. 

THE  ORIGIN  AND  PROGRESS  OF  MEDICAL  ETHICS  TO  THE  END  OF 
THE  NINETEENTH  CENTURY. 

Medical  Ethics  is  that  branch  of  moral  philosophy  which 
treats  of  the  duties,  responsibilities  and  rights  of  members  of 
the  medical  profession  in  relation  to  the  nature  of  their  call- 
ing, their  relation  to  each  other  and  their  relations  to  the 
whole  community.  General  ethics  or  moral  philosophy  has 
occupied  the  attention  of  the  most  learned  men  in  all  ages 
past,  and  has  ever  been  closely  connected  with  the  co-incident 
systems  of  religion. 

The  earliest  attempts  to  formulate  definite  rules  of  con- 
duct for  the  guidance  of  physicians,  of  which  we  have  any 
reliable  account,  were  made  in  Greece  when  both  medical 
teaching  and  practice  were  chiefly  connected  with  the  As- 
clepiadse  and  temples  for  worship,  and  had  for  their  chief 
objects  the  perpetuation  of  the  doctrines  of  each  school  by 
the  pupils,  their  support  of  each  other,  and  the  prevention  of 
improper  persons  from  entering  their  ranks. 

Pythagoras,  about  550  B.  C.,  endeavored  to  organize  his 
followers  in  a  club  or  sect  with  definite  rules  for  the  main- 
tenance of  both  high  character  and  judicious  modes  of  liv- 
ing. The  teaching  of  Socrates  was  still  more  ethical,  but 
the  earliest  attempt  to  formulate  a  medical  code  that  has 
been  preserved  in  writing  is  known  as  the  Hippocratic  Oath, 
and  is  as  follows :  "I  swear  by  Apollo,  the  physician ;  by 
^sculapius,  by  Hygeia,  by  Panacea,  and  all  of  the  Gods  and 
Goddesses,  that  according  to  my  ability  and  judgment,  I  will 
keep  this  oath  and  stipulation,  to  reckon  him  who  teaches 
me  this  art  equally  dear  to  me  as  my  parents ;  to  share  my 
substance  with  him  and  relieve  his  necessities  if  required; 
to  look  upon  his  offspring  on  the  same  footing  as  my  own 
brothers,  and  to  teach  them  this  art  if  they  shall  wish  to 
learn  it,  without  fee  or  stipulation ;  and  that  by  precept,  lec- 
'  tufe  and  every  other  mode  of  instruction,  I  will  impart  a 
knowledge  of  this  art  to  my  own  sons,  to  those  of  my  teach- 


i88 

ers,  and  to  disciples  bound  by  a  stipulation  and  oath  accord- 
ing to  the  law  of  medicine,  but  to  no  others.  I  will  follow 
that  system  of  regimen,  which,  according  to  my  ability  and 
judgment,  I  consider  for  the  benefit  of  my  patients;  and 
abstain  from  whatever  is  deleterious  and  mischievous ;  I  will 
give  no  deadly  medicine  to  any  one,  if  asked,  nor  suggest 
any  such  counsel ;  and  in  like  manner  I  will  not  give  a  wom- 
an a  pessary  to  produce  an  abortion.  With  purity  and  with 
holiness  I  will  pass  my  life  and  practise  my  art.  I  will  not 
cut  persons  laboring  under  the  stone,  but  will  leave  this  to 
be  done  by  men  who  are  practitioners  of  this  work.  Into 
whatever  houses  I  enter,  I  will  go  into  them  for  the  benefit 
of  the  sick,  and  will  abstain  from  every  voluntary  act  of 
mischief  and  corruption ;  and  further,  from  the  seduction  of 
females  and  males,  of  freemen  and  slaves.  Whatever  in 
connection  with  my  professional  practice,  or  not  in  connec- 
tion with  it,  I  see  or  hear,  I  will  not  divulge  as  reckoning  that 
all  such  things  should  be  kept  secret.  While  I  continue  to 
keep  this  oath  inviolate,  may  it  be  granted  to  me  to  enjoy  life 
and  the  practice  of  my  art,  respected  by  all  men  at  all  times. 
But  should  I  trespass  and  violate  this  oath,  may  the  reverse 
be  my  lot." 

This  oath  constituted  substantially  the  ethical  code  of  all 
the  Asclepiadae  until  their  suppression  by  the  spread  of  the 
Christian  religion.  Even  then  the  same  principles  were 
adopted  in  the  monasteries,  hospitals,  and  medical  schools 
that  succeeded  under  the  first  ten  centuries  of  the  Christian 
dispensation.  An  attentive  reading  of  the  text  as  translated 
from  its  original  Greek  shows  that  its  author  had  four  lead- 
ing objects  JTti  view. 

First,  that  every  physician  should  feel  a  profound  re- 
spect and  gratitude  for  his  medical  teachers,  and  be  ready  at 
all  times  to  extend  to  them  the  same  aid  as  to  his  own  kin- 
dred. 

Second,  that  he  should  teach  his  own  sons  and  his  teach- 
er's sons,  if  they  desired  it,  the  same  art  of  medicine  fully 
and  free  of  charge,  and  to  no  others  except  such  disciples  as 
bound  themselves  by  stipulation  and  oath  to  observe  the  law 


189 

of  medicine ;  thereby  fostering  a  distinct  hereditary  tendency 
in  the  perpetuation  of  the  profession. 

Third,  that  the  paramount  objects  of  all  medical  prac- 
tice are  to  benefit  the  sick,  to  relieve  human  suffering,  and 
to  prolong  human  life ;  and  not  for  mere  pecuniary  gain. 

Fourth,  that  a  life  of  virtue,  temperance  and  integrity  on 
the  part  of  the  physician  is  essential  both  for  his  own  suc- 
cess and  for  the  safety  of  his  patients;  thereby  indicating 
that  personal  example  is  more  influential  than  precept. 

The  foregoing  ethical  principles  and  objects  were  ad- 
mirably illustrated  both  in  the  writing  and  the  conduct  of 
Hippocrates.  And  their  beneficial  influence  can  be  easily 
traced  through  even  the  darkest  periods  of  European  history, 
though  their  practical  application  was  often  interfered  with 
by  the  almost  constant  wars,  and  the  frequent  attempts  to 
enforce  ecclesiastical  authority. 

It  was  not  until  the  end  of  the  eigtheenth  century  that  the 
Hippocratic  code  was  more  fully  discussed,  revised  and  ex- 
tended by  Sir  Thomas  Percival,  an  eminent  English  physi- 
cian, born  in  Warrington,  England,  September  29th,  1740. 
He  was  educated  at  the  Warrington  Academy  and  the  Uni- 
versity of  Edinburgh,  completed  his  medical  studies  and  re- 
ceived the  degree  of  M.  D.  at  Leyden  in  1765.  Two  years 
later  he  commenced  the  practice  of  his  profession  in  Man- 
chester, and  in  1781  was  one  of  the  chief  founders  of  the 
Manchester  literary  and  philosophical  society.  He  made 
several  valuable  contributions  to  the  "Philosophical  Trans- 
actions" of  London  and  of  Manchester. 

Later  in  life,  he  wrote  much  on  moral  and  literary  topics 
and  enjoyed  a  high  reputation.  In  1803  ^e  published  his 
work  entitled  "Medical  Ethics,  or  a  Code  of  Institutes  and 
Precepts  adapted  to  the  Professional  Conduct  of  Physicians 
and  Surgeons."  He  died  in  Manchester,  August  30th,  1804. 
After  his  death  all  his  important  works  were  collected  and 
published  by  his  son  in  four  volumes,  octavo,  in  London  in 
1807.  His  work  on  Medical  Ethics  embraced  a  full  and  very 
interesting  discussion  of  the  nature  of  the  physician's  calling ; 
the  duties  of  the  physician  to  his  patients  and  the  obligations 
of  the  patient  to  his  physician ;  the  duties  of  physicians  to  each 


190 

other  and  to  the  profession  at  large;  and  the  duties  of  the 
profession  to  the  pubUc  and  the  obligations  of  the  public  to 
the  profession.  It  was  received  with  so  much  favor  that  it 
speedily  became  the  standard  authority  on  medical  ethics  by 
the  profession  of  Great  Britain  and  her  colonies,  and  has  con- 
tinued such  until  the  present  time. 

Dr.  John  Gregory,  when  at  the  head  of  the  medical  fac- 
ulty of  the  University  of  Edinburgh,  in  a  series  of  lectures, 
discussed  very  fully  the  duties  of  the  physician.  He  was 
followed  on  the  same  subject  by  Dr.  Benjamin  Rush,  of  Phil- 
adelphia, and  as  medical  societies  multiplied  during  the  first 
half  of  the  nineteenth  century,  many  of  them  adopted  the 
leading  sentiments  of  Percival's  code  either  in  their  by-laws 
or  in  brief  codes  of  their  own  compilation.  One  of  the  most 
formal  of  the  latter  class  was  imanimously  adopted  by  the 
New  York  State  Medical  Society  in  1823,  as  reported  by  a 
committee  of  which  Dr.  J.  R.  Manley  was  chairman.  It 
was  called  a  "System  of  Medical  Ethics",  and  was  considered 
in  five  divisions,  namely :  1st.  Personal  Character  of  Phy- 
sicians. 2nd.  Quackery.  3rd.  Consultations.  4th.  Specifi- 
cations of  Medical  Police  in  Practice.  5th.  Forensic  IMed- 
ical  Police.  At  the  national  Convention  of  delegates  from 
the  local  and  state  medical  societies^  medical  colleges  and 
hospitals,  in  the  United  States,  held  in  New  York  in  May, 
1846,  the  following  resolution  was  adopted: 

"Resolved,  That  it  is  expedient  that  the  medical  pro- 
fession of  the  United  States  should  be  governed  by  the  same 
code  of  medical  ethics,  and  that  a  committee  of  seven  be  ap- 
pointed to  report  a  code  for  that  purpose,  at  a  meeting  to 
be  held  at  Philadelphia  on  the  first  Wednesday  of  May, 
1847."  The  committee  appointed  for  that  purpose  consisted 
of  Drs.  John  Bell,  Isaac  Hays,  and  G.  Emerson,  of  Phila- 
delphia ;  W.  W.  Morris,  of  Dover,  in  Del. ;  T.  C.  Dunn, 
Newport,  R.  I. ;  A.  Clark,  of  New  York;  and  R.  D.  Arnold, 
of  Savannah,  Ga.  This  committee,  at  the  convention  in 
Philadelphia,  1847,  made  an  interesting  report,  accompanied 
by  a  more  complete  code  of  medical  ethics  than  any  pre- 
viously devised.  It  was  adopted  by  unanimous  vote  of  the 
convention ;  and  as  that  body  at  the  same  meeting  resolved 


191 

itself  into  the  permanent  American  Medical  Association,  it 
became  the  code  of  that  organization,  and  was  fully  recog- 
nized in  its  constitution  and  by-laws.  Its  principles  and 
much  of  its  language  were  copied  from  the  work  of  Dr.  Per- 
cival,  though  some  important  paragraphs  are  nearly  in  the 
words  of  Drs.  Gregory  and  Rush ;  all  of  which  was  fully  ac- 
knowledged by  the  committee  in  a  note  appended  to  their 
report. 

The  leading  purpose  prompting  the  formulation  of  the 
code  was  to  obtain  a  com.mon  and  just  standard  of  profes- 
sional rights  and  duties,  to  guide  the  medical  men  in  all 
the  states  of  the  American  Union.  And  as  the  American 
Medical  Association  organized  at  that  time  was  to  be  a 
strictly  representative  body  composed  of  delegates  from  the 
several  State,  District  and  County  Medical  Societies  in  all 
the  states,  it  adopted  as  one  of  its  by-laws  the  following  in 
1865 :  "No  State  or  Local  Medical  Society,  or  other  organ- 
ized institution,  shall  be  entitled  to  representation  in  this 
Association  that  has  not  adopted  its  Code  of  Ethics ;  or  that 
has  intentionally  violated  or  disregarded  any  article  or  clause 
of  the  same." 

In  accordance  with  this  by-law,  nearly  all  the  regular 
State  and  Local  Medical  Societies  have  adopted  the  same 
Code  of  Ethics,  and  it  remains  in  full  force  at  the  present 
time ;  and  is  in  the  following  language : 

Art.  I. — Duties  of  physicians  to  their  patients. 

Section  i.  A  physician  should  not  only  be  ever  ready  to 
obey  the  calls  of  the  sick,  but  his  mind  ought  also  to  be  im- 
bued with  the  greatness  of  his  mission,  and  the  responsibility 
he  habitually  incurs  in  its  discharge.  These  obligations  are 
the  more  deep  and  enduring,  because  there  is  no  tribunal 
other  than  his  own  conscience  to  adjudge  penalties  for  care- 
lessness or  neglect.  Physicians  should,  therefore,  minister 
to  the  sick  with  due  impressions  of  the  importance  of  their 
office;  reflecting  that  the  ease,  the  health,  and  the  lives  of 
those  committed  to  their  charge,  depend  on  their  skill,  at- 
tention, and  fidelity.  They  should  study,  also,  in  their  de- 
portment, so  to  unite  tenderness  with  firmness,  and  conde- 


192 

SCension  with  authority,  as  to  inspire  the  minds  of  their  pa- 
tients with  gratitude,  respect,  and  confidence. 

Section  2.  Every  case  committed  to  the  charge  of  a  phy- 
sician should  be  treated  with  attention,  steadiness  and  hu- 
manity. Reasonable  indulgence  should  be  granted  to  the 
mental  imbecility  and  caprices  of  the  sick.  Secrecy  and  deli- 
cacy, when  required  by  peculiar  circumstances,  should  be 
strictly  observed ;  and  the  familiar  and  confidential  inter- 
course to  which  physicians  are  admitted  in  their  professional 
visits,  should  be  used  with  discretion,  and  with  the  most  scru- 
pulous regard  to  fidelity  and  honor.  The  obligation  of  se- 
crecy extends  beyond  the  period  of  professional  services ; 
none  of  the  privacies  of  personal  and  domestic  life,  no  in- 
firmity of  disposition  or  flaw  of  character  observed  during 
professional  attendance  should  ever  be  divulged  by  the  phy- 
sician except  when  he  is  imperatively  required  to  do  so.  The 
force  and  necessity  of  this  obligation  are  indeed  so  great, 
that  professional  men  have,  under  certain  circumstances, 
been  protected  in  their  observance  of  secrecy  by  courts  of 
justice. 

Section  3.  Frequent  visits  to  the  sick  are  in  general 
requisite,  since  they  enable  the  physician  to  arrive  at  a  more 
perfect  knowledge  of  the  disease — to  meet  promptly  every 
change  which  may  occur,  and  also  tend  to  preserve  the  con- 
fidence of  the  patient.  But  unnecessary  visits  are  to  be 
avoided,  as  they  give  useless  anxiety  to  the  patient,  tend  to 
diminish  the  authority  of  the  physician,  ahd  render  him  lia- 
ble to  be  suspected  of  interested  motives. 

Section  4.  A  physician  should  not  be  forward  to  make 
gloomy  prognostications,  because  they  savor  of  empiricism, 
by  magnifying  the  importance  of  his  services  in  the  treat- 
ment or  cure  of  the  disease.  But  he  should  not  fail,  on  prop- 
er occasions,  to  give  to  the  friends  of  the  patient  timely  no- 
tice of. danger  when  it  really  occurs;  and  even  to  the  patient 
himself,  if  absolutely  necessary.  This  officce,  however,  is  so 
peculiarly  alarming  when  executed  by  him,  that  it  ought  to 
be  declined  whenever  it  can  be  assigned  to  any  other  person 
of  sufficient  judgment  and  delicacy.  For  the  physician  should 
be  the  minister  of  hope  and  comfort  to  the  sick ;  that,  by  such 


193 

cordials  to  the  drooping  spirit,  he  may  soothe  the  bed  of 
death,  revive  expiring  Ufe,  and  counteract  the  depressing 
influence  of  those  maladies  which  often  disturb  the  tran- 
quility of  the  most  resigned  in  their  last  moments.  The  life 
of  a  sick  person  can  be  shortened  not  only  by  the  acts,  but 
also  by  the  words  or  the  manner  of  a  physician.  It  is,  there- 
fore, a  sacred  duty  to  guard  himself  carefully  in  this  respect, 
and  to  avoid  all  things  which  have  a  tendency  to  discourage 
the  patient  and  to  depress  his  spirits. 

Section  5.  A  physician  ought  not  to  abandon  a  patient 
because  the  case  is  deemed  incurable ;  for  his  attendance  may 
continue  to  be  highly  useful  to  the  patient,  and  comforting  to 
the  relatives  around  him,  even  in  the  last  period  of  a  fatal 
malady,  by  alleviating  pain  and  other  symptoms,  and  by 
soothing  mental  anguish.  To  decline  attendance,  under  such 
circumstances,  would  be  sacrificing  to  fanciful  delicacy  and 
mistaken  liberality,  that  moral  duty  which  is  independent  of, 
and  far  superior  to,  all  pecuniary  consideration. 

Section  6.  Consultations  should  be  promoted  in  difficult 
or  protracted  cases,  as  they  give  rise  to  confidence,  energy, 
and  more  enlarged  views  in  practice. 

Section  7.  The  opportunity  which  a  physician  not  unfre- 
quently  enjoys  of  promoting  and  strengthening  the  good  res- 
olutions of  his  patients,  suffering  under  the  consequences  of 
vicious  conduct,  ought  never  to  be  neglected.  His  counsels, 
or  even  remonstrances,  will  give  satisfaction,  not  ofifense,  if 
they  be  proffered  with  politeness,  and  evince  a  genuine  love 
of  virtue,  accompanied  by  a  sincere  interest  in  the  welfare  of 
the  person  to  whom  they  are  addressed. 

Art.  II. — Obligations  of  patients  to  their  physicians. 

Section  i.  The  members  of  the  medical  profession,  upon 
whom  is  enjoined  the  performance  of  so  many  important  and 
arduous  duties  toward  the  community,  and  who  are  required 
to  make  so  many  sacrifices  of  comfort,  ease,  and  health,  for 
the  welfare  of  those  who  avail  themselves  of  their  services, 
certainly  have  a  right  to  expect  and  require,  that  their  pa- 
tients should  entertain  a  just  sense  of  the  duties  which  they 
owe  to  their  medical  attendants. 

Section  2.     The  first  duty  of  a  patient  is  to  select  as  his 


194 

medical  adviser  one  who  has  received  a  regular  professional 
education.  In  no  trade  or  occupation  do  mankind  rely  on  the 
skill  of  an  untaught  artist ;  and  in  medicine,  confessedly  the 
most  difficult  and  intricate  of  the  sciences,  the  world  ought 
not  to  suppose  that  knowledge  is  intuitive. 

Section  3.  Patients  should  prefer  a  physician  whose  hab- 
its of  life  are  regular,  and  who  is  not  devoted  to  company, 
pleasure,  or  to  any  pursuit  incompatible  with  his  professional 
obligations.  A  patient  should,  also,  confide  the  care  of  him- 
self and  family,  as  much  as  possible,  to  one  physician ;  for  a 
medical  man  who  has  become  acquainted  with  the  peculiari- 
ties of  constitution,  habits,  and  predispositions  of  those  he  at- 
tends, is  more  likely  to  be  successful  in  his  treatment  than 
one  who  does  not  possess  that  knowledge. 

A  patient  who  has  thus  selected  his  physician  should  al- 
ways apply  for  advice  in  what  may  appear  to  him  trivial 
cases,  for  the  most  fatal  results  often  super\-ene  on  the  slight- 
est accidents.  It  is  of  still  more  importance  that  he  should 
apply  for  assistance  in  the  forming  stage  of  violent  diseases ; 
it  is  to  a  neglect  of  this  precept  that  medicine  owes  much  of 
the  uncertainty  and  imperfection  with  which  it  has  been 
reproached. 

Section  4.  Patients  should  faithfully  and  unreservedly 
communicate  to  their  physician  the  supposed  cause  of  their 
disease.  This  is  the  more  important,  as  many  diseases  of  a 
mental  origin  simulate  those  depending  on  external  causes, 
and  yet  are  only  to  be  cured  by  ministering  to  the  mind  dis- 
eased. A  patient  should  never  be  afraid  of  thus  making  his 
physician  his  friend  and  adviser;  he  should  always  bear  in 
mind  that  a  medical  man  is  under  the  strongest  obligations  of 
secrecy.  Even  the  female  sex  should  never  allow  feelings  of 
shame  or  delicacy  to  prevent  their  disclosing  the  seat,  symp- 
toms, and  causes  of  complaints  peculiar  to  them.  However 
commendable  a  modest  reserve  may  be  in  the  common  occur- 
rences of  life,  its  strict  observance  in  medicine  is  often  at- 
tended with  the  most  serious  consequences,  and  a  patient  may 
sink  under  a  painful  and  loathsome  disease,  which  might 
have  been  readily  prevented  had  timely  intimation  been  given 
to  the  physician. 


195 

Section  5.  A  patient  should  never  weary  his  physician 
with  a  tedious  detail  of  events  or  matters  not  appertaining 
to  his  disease.  Even  as  relates  to  his  actual  symptoms,  he 
will  convey  much  more  real  information  by  giving  clear  an- 
swers to  interrogatories,  than  by  the  most  minute  account 
of  his  own  framing.  Neither  should  he  obtrude  upon  his 
physician  the  details  of  his  business  nor  the  history  of  his 
family  concerns. 

Section  6.  The  obedience  of  a  patient  to  the  prescriptions 
of  his  physician  should  be  prompt  and  implicit.  He  should 
never  permit  his  own  crude  opinions  as  to  their  fatness  to  in- 
fluence his  attention  to  them.  A  failure  in  one  particular 
may  render  an  otherwise  judicious  treatment  dangerous,  and 
even  fatal.  This  remark  is  equally  applicable  to  diet,  drink, 
and  exercise.  As  patients  become  convalescent  they  are  very 
apt  to  suppose  that  the  rules  prescribed  for  them  may  be  dis- 
regarded, and  the  consequence,  but  too  often,  is  a  relapse. 
Patients  should  never  allow  themselves  to  be  persuaded  to 
take  any  medicine  whatever,  that  may  be  recommended  to 
them  by  the  self-constituted  doctors  and  doctresses  who  are 
so  frequently  met  with,  and  who  pretend  to  possess  infalli- 
ble remedies  for  the  cure  of  every  disease.  However  simple 
some  of  their  prescriptions  may  appear  to  be,  it  often  hap- 
pens that  they  are  productive  of  much  mischief,  and  in  all 
cases  they  are  injurious,  by  contravening  the  plan  of  treat- 
ment adopted  by  the  physician. 

Section  7.  A  patient  should,  if  possible,  avoid  even  the 
friendly  visits  of  a  physician  who  is  not  attending  him — and 
when  he  does  receive  them,  he  should  never  converse  on  the 
subject  of  his  disease,  as  an  observation  may  be  made,  with- 
out any  intention  of  interference,  which  may  destroy  his  con- 
fidence in  the  course  he  is  pursuing,  and  induce  him  to  neg- 
lect the  directions  prescribed  to  him.  A  patient  should  never 
send  for  a  consulting  physician  without  the  express  consent 
of  his  own  medical  attendant.  It  is  of  great  importance  that 
physicians  should  act  in  concert;  for,  although  their  modes 
of  treatment  may  be  attended  with  equal  success  when  ap- 
plied singly,  yet  conjointly  they  are  ver\'  likely  to  be  pro- 
ductive of  disastrous  results. 


196 

Section  8.  When  a  patient  wishes  to  dismiss  his  physi- 
cian, justice  and  common  courtesy  require  that  he  should  de- 
clare his  reasons  for  so  doing. 

Section  9.  Patients  should  always,  when  practicable, 
send  for  their  physician  in  the  morning,  before  his  usual  hour 
of  going  out ;  for,  by  being  early  aware  of  the  visits  he  has  to 
pay  during  the  day,  the  physician  is  able  to  apportion  his 
time  in  such  a  manner  as  to  prevent  an  interference  of  en- 
gagements. Patients  should  also  avoid  calling  on  their  med- 
ical adviser  unnecessarily  during  the  hours  devoted  to  meals 
or  sleep.  They  should  always  be  in  readiness  to  receive  the 
visits  of  their  physician,  as  the  detention  of  a  few  minutes  is 
often  of  serious  inconvenience  to  him. 

Section  10.  A  patient  should,  after  his  recovery,  enter- 
tain a  just  and  endearing  sense  of  the  value  of  the  services 
rendered  him  by  his  physician ;  for  these  are  of  such  a  char- 
acter, that  no  mere  pecuniary  acknowledgment  can  repay  or 
cancel  them. 

OF  THE  DUTIES  OF  PHYSICIANS  TO  EACH  OTHER,  AND  TO  THE 
PROFESSION  AT  LARGE. 

Art.  I. — Dvities  for  the  support  of  professional  character. 

Section  i.  Every  individual,  on  entering  the  profession, 
as  he  becomes  thereby  entitled  to  all  its  privileges  and  im- 
munities, incurs  an  obligation  to  exert  his  best  abilities  to 
maintain  its  dignity  and  honor,  to  exalt  its  standing,  and  to 
extend  the  bounds  of  its  usefulness.  He  should,  therefore, 
observe  strictly  such  laws  as  are  instituted  for  the  govern- 
ment of  its  members ;  should  avoid  all  contumelious  and  sar- 
castic remarks  relative  to  tlie  faculty  as  a  body ;  and  while, 
by  unwearied  diligence,  he  resorts  to  every  honorable  means 
of  enriching  the  science,  he  should  entertain  a  due  respect 
for  his  seniors,  who  have,  by  their  labors,  brought  it  to  the 
elevated  condition  in  which  he  finds  it. 

Section  2.  It  is  not  in  accord  with  the  interests  of  the 
public  or  the  honor  of  the  profession  that  any  physician  or 
medical  teacher  should  examine  or  sign  diplomas  or  certifi- 
cates of  proficiency  for,  or  otherwise  be  specially  concerned 
with,  the  graduation  of  persons  whom  they  have  good  rea- 


197 

son  to  believe  intend  to  support  and  practice  any  exclusive 
and  irregular  system  of  medicine. 

Section  3.  There  is  no  profession  from  the  members  of 
which  greater  purity  of  character  and  a  higher  standard  of 
moral  excellence  are  required,  than  the  medical ;  and  to  attain 
such  eminence  is  a  duty  every  physician  owes  alike  to  his 
profession  and  to  his  patients.  It  is  due  to  the  latter,  as  with- 
out it  he  cannot  command  their  respect  and  confidence,  and 
to  both,  because  no  scientific  attainments  can  compensate  for 
the  want  of  correct  moral  principles.  It  is  also  incumbent 
upon  the  faculty  to  be  temperate  in  all  things,  for  the  prac- 
tice of  physic  requires  the  unremitting  exercise  of  a  clear  and 
vigorous  understanding;  and,  on  emergencies,  for  which  no 
professional  man  should  be  unprepared,  a  steady  hand,  an 
acute  eye,  and  an  unclouded  head  may  be  essential  to  the 
well-being,  and  even  to  the  life,  of  a  fellow-creature. 

Section  4.  It  is  derogatory  to  the  dignity  of  the  profes- 
sion to  resort  to  public  advertisements,  or  private  cards,  or 
handbills,  inviting  the  attention  of  individuals  affected  with 
particular  diseases — publicly  offering  advice  and  medicine 
to  the  poor  gratis,  or  promising  radical  cures ;  or  to  publish 
cases  and  operations  in  the  daily  prints,  or  suffer  such  pub- 
lications to  be  made ;  to  invite  laymen  to  be  present  at  op- 
erations, to  boast  of  cures  and  remedies,  to  adduce  certifi- 
cates of  skill  and  success,  or  to  perform  any  other  similar 
acts.  These  are  the  ordinary  practices  of  empirics  and  are 
highly  reprehensible  in  a  regular  physician. 

Section  5.  Equally  derogatory  to  professional  character 
is  it  for  a  physician  to  hold  a  patent  for  any  surgical  instru- 
ment or  medicine ;  or  to  dispense  a  secret  nostrum,  whether 
it  be  the  composition  or  exclusive  property  of  himself  or 
of  others.  For,  if  such  nostrum  be  of  real  efficacy,  any  con- 
cealment regarding  it  is  inconsistent  with  beneficence  and 
professional  liberality ;  and  if  mystery  alone  give  it  value  and 
importance,  such  craft  implies  either  disgraceful  ignorance 
or  fraudulent  avarice.  It  is  also  reprehensible  for  physicians 
to  give  certificates  attesting  the  efiicacy  of  patent  or  secret 
medicines,  or  in  any  way  to  promote  the  use  of  them. 


198 

Art.  1 1. ^-Professional  services  of  physicians  to  each  other. 
Section  i.  All  practitioners  of  medicine,  their  wives,  and 
their  children  while  under  the  paternal  care,  are  entitled  to 
the  gratuitous  services  of  any  one  or  more  of  the  faculty  re- 
siding near  them,  whose  assistance  may  be  desired.  A  phy- 
sician afflicted  with  disease  is  usually  an  incompetent  judge  of 
his  own  case;  and  the  natural  anxiety  and  solicitude  which 
he  experiences  at  the  sickness  of  a  wife,  a  child,  or  any  one 
who,  by  ties  of  consanguinity,  is  rendered  peculiarly  dear 
to  him,  tend  to  obscure  his  judgment,  and  produce  timidity 
and  irresolution  in  his  practice.  Under  such  circumstances, 
medical  men  are  peculiarly  dependent  upon  each  other,  and 
kind  offices  and  professional  aid  should  always  be  cheerfully 
and  gratuitously  afforded.  Visits  ought  not,  however,  to  be 
obtruded  officiously ;  as  such  unasked  civility  may  give  rise 
to  embarrassment,  or  interfere  with  that  choice  on  which  con- 
fidence depends.  But,  if  a  distant  member  of  the  faculty, 
whose  circumstances  are  affluent,  request  attendance,  and  an 
honorarium  be  offered,  it  should  not  be  declined ;  for  no  pe- 
cuniary obligation  ought  to  be  imposed,  which  the  party  re- 
ceiving it  would  wish  not  to  incur. 

Art.  III. — Of  the  duties  of  physician  as  respects  vicarious 

offices. 
Section  i.  The  affairs  of  life,  the  pursuit  of  health,  and 
the  various  accidents  and  contingencies  to  which  a  medical 
man  is  peculiarly  exposed,  sometimes  require  him  temporari- 
ly to  withdraw  from  his  duties  to  his  patients,  and  to  request 
some  of  his  professional  brethren  to  officiate  for  him.  Compli- 
ance with  this  request  is  an  act  of  courtesy,  which  should  al- 
ways be  performed  with  the  utmost  consideration  for  the 
interest  and  character  of  the  family  physician,  and  when  ex- 
ercised for  a  short  period  all  the  pecuniary  obligations  for 
such  services  should  be  awarded  to  him.  But  if  a  member 
of  the  profession  neglect  his  business  in  quest  of  pleasure 
and  amusement,  he  cannot  be  considered  as  entitled  to  the 
advantages  of  the  frequent  and  long-continued  exercise  of 
this  fraternal  courtesy  without  awarding  to  the  physician 
who  officiates  the  fees  arising  from  the  discharge  of  his  pro- 
fessional duties. 


199 

In  obstetrical  and  important  surgical  cases,  which  give 
rise  to  unusual  fatigue,  anxiety  and  responsibility,  it  is  just 
that  the  fees  accruing  therefrom  should  be  awarded  to  the 
physician  who  officiates. 

Art.  IV. — Of  the  duties  of  physicians  in  regard  to 
consultations. 

Section  i.  A  regular  medical  education  furnishes  the 
only  presumptive  evidence  of  professional  abilities  and  ac- 
quirements, and  ought  to  be  the  only  acknowledged  right  of 
an  individual  to  the  exercise  and  honors  of  his  profession. 
Nevertheless,  as  in  consultations  the  good  of  the  patient  is 
the  sole  object  in  view,  and  this  is  often  dependent  on  per- 
sonal confidence,  no  intelligent  regular  practitioner,  who  has 
a  license  to  practice  from  some  medical  board  of  known  and 
acknowledged  respectability,  recognized  by  the  Association, 
and  who  is  in  good  moral  and  professional  standing  in  the 
place  in  which  he  resides,  should  be'  fastidiously  excluded 
from  fellowship,  or  his  aid  refused  in  consultation,  when  it 
is  requested  by  the  patient.  But  no  one  can  be  considered 
as  a  regular  practitioner  or  a  fit  associate  in  consultation, 
whose  practice  is  based  on  an  exclusive  dogma,  to  the  re- 
jection of  the  accumulated  experience  of  the  profession,  and 
of  the  aids  actually  furnished  by  anatomy,  physiology, 
pathology  and  organic  chemistry. 

Section  2.  In  consultations,  no  rivalship  or  jealousy 
should  be  indulged;  candor,  probity,  and  all  due  respect 
should  be  exercised  toward  the  physician  having  charge  of 
the  case. 

Section  3.  In  consultation,  the  attending  physician  should 
be  the  first  to  propose  the  necessary  questions  to  the  sick; 
after  which  the  consulting  physician  should  have  the  oppor- 
tunity to  make  such  further  inquiries  of  the  patient  as  may 
be  necessary  to  satisfy  him  of  the  true  character  of  the  case. 
Both  physicians  should  then  retire  to  a  private  place  for  de- 
liberation ;  and  the  one  first  in  attendance  should  communi- 
cate the  directions  agreed  upon  to  the  patient  or  his  friends, 
as  well  as  any  opinions  which  it  may  be  thought  proper  to 
express.  But  no  statement  or  discussion  of  it  should  take 
place  before  the  patient  or  his  friends,  except  in  the  presence 


20O 

of  all  the  faculty  attending,  and  by  their  common  consent; 
and  no  opinions  or  prognostications  should  be  delivered 
which  are  not  the  result  of  previous  deliberation  and  con- 
currence. 

Section  4.  In  consultations,  the  physician  in  attendance 
should  deliver  his  opinion  first;  and  when  there  are  several 
consulting,  they  should  deliver  their  opinions  in  the  order  in 
which  they  have  been  called.  No  decision,  however,  should 
restrain  the  attending  physician  from  making  such  variations 
in  the  mode  of  treatment  as  any  subsequent  unexpected 
change  in  the  character  of  the  case  may  demand.  But  such 
variation,  and  the  reasons  for  it,  ought  to  be  carefully  de- 
tailed at  the  next  meeting  in  consultation.  The  same  priv- 
ilege belongs  also  to  the  consulting  physician  if  he  is  sent  for 
in  an  emergency,  when  the  regular  attendant  is  out  of  the 
way,  and  similar  explanations  must  be  made  by  him  at  the 
next  consultation. 

Section  5.  The  utmost  punctuality  should  be  observed  in 
the  visits  of  physicians  when  they  are  to  hold  consultations 
together,  and  this  is  generally  practicable,  for  society  has 
been  considerate  enough  to  allow  the  plea  of  a  professional 
engagement  to  take  precedence  of  all  others,  and  to  be  an 
ample  reason  for  the  relinquishment  of  any  present  occupa- 
tion. But  as  professional  engagements  may  sometimes  in- 
terfere, and  delay  one  of  the  parties,  the  physician  who  first 
arrives  should  wait  for  his  associate  a  reasonable  period, 
after  which  the  consultation  should  be  considered  as  post- 
poned to  a  new  appointment.  If  it  be  the  attending  physician 
who  is  present,  he  will,  of  course,  see  the  patient  and  pre- 
scribe; but  if  it  be  the  consulting  one,  he  shoiWd  retire,  ex- 
cept in  case  of  emergency,  or  when  he  has  been  called  from 
a  considerable  distance,  in  which  latter  case  he  may  examine 
the  patient,  and  give  his  opinion  in  writing  and  under  seal, 
to  be  delivered  to  his  associate. 

Section  6.  In  consultations,  theoretical  discussions  should 
be  avoided,  as  occasioning  perplexity  and  loss  of  time.  For 
there  may  be  much  diversity  of  opinion  concerning  specu- 
lative points,   with   perfect  agreement  in  those  modes   of 


201 

practice  which  are  founded,  not  on  hypothesis,  but  on  expe- 
rience and  observation. 

Section  7.  All  discussions  in  consultation  should  be  held 
as  secret  and  confidential.  Neither  by  words  nor  manner 
should  any  of  the  parties  to  a  consultation  assert  or  insinuate 
that  any  part  of  the  treatment  pursued  did  not  receive  his 
assent.  The  responsibility  must  be  equally  divided  between 
the  medical  attendants — they  must  equally  share  the  credit 
of  success  as  well  as  the  blame  of  failure. 

Section  8.  Should  an  irreconcilable  diversity  of  opinion 
occur  when  several  physicians  are  called  upon  to  consult  to- 
gether, the  opinion  of  the  majority  should  be  considered  as 
decisive ;  but  if  the  numbers  be  equal  on  each  side,  then  the 
decision  should  rest  with  the  attending  physician.  It  may, 
moreover,  sometimes  happen  that  two  physicians  cannot 
agree  in  their  views  of  the  nature  of  a  case,  and  the  treatment 
to  be  pursued.  This  is  a  circumstance  much  to  be  deplored, 
and  should  always  be  avoided,  if  possible,  by  mutual  conces- 
sions, as  far  as  they  can  be  justified  by  a  conscientious  re- 
gard for  the  dictates  of  judgment.  But  in  the  event  of  its 
occurrence,  a  third  physician  should,  if  practicable,  be  called 
to  act  as  umpire ;  and,  if  circumstances  prevent  the  adoption 
of  this  course,  it  must  be  left  to  the  patient  to  select  the  phy- 
sician in  which  he  is  most  willing  to  confide.  But,  as  every 
physician  relies  upon  the  rectitude  of  his  judgment,  he 
should,  when  left  in  the  minority,  politely  and  consistently 
retire  from  any  further  deliberation  in  the  consultation,  or 
participation  in  the  management  of  the  case. 

Section  9.  As  circumstances  sometimes  occur  to  render 
a  special  consultation  desirable,  when  the  continued  attend- 
ance of  two  physicians  might  be  objectionable  to  the  patient, 
the  member  of  the  faculty  whose  assistance  is  required  in 
such  cases  should  sedulously  guard  against  all  future  unso- 
licited attendance.  As  such  consultations  require  an  extraor- 
dinary portion  of  both  time  and  attention,  at  least  a  double 
honorarium  may  be  reasonably  expected. 

Section  10.  A  physician  who  is  called  upon  to  consult, 
should  observe  the  most  honorable  and  scrupulous  regard  for 
the  character  and  standing  of  the  practitioner  in  attendance ; 


202 

the  practice  of  the  latter,  if  necessary,  should  be  justified  as 
far  as  it  can  be,  consistently  with  a  conscientious  regard  for 
truth,  and  no  hint  or  insinuation  should  be  thrown  out  which 
could  impair  the  confidence  reposed  in  him,  or  affect  his  rep- 
utation. The  consulting  physician  should  also  carefully  re- 
frain from  any  of  those  extraordinary  attentions  or  assidu- 
ities which  are  too  often  practiced  by  the  dishonest  for  the 
base  purpose  of  gaining  applause,  or  ingratiating  themselves 
into  the  favor  of  families  and  individuals. 

Art.  V. — Duties  of  physicians  in  cases  of  interference. 

Section  i.  Medicine  is  a  liberal  profession,  and  those  ad- 
mitted to  its  ranks  should  found  their  expectations  of  prac- 
tice upon  the  extent  of  their  qualifications,  not  on  intrigue  or 
artifice. 

Section  2.  A  physician,  in  his  intercourse  with  a  patient 
under  the  care  of  another  practitioner,  should  observe  the 
strictest  caution  and  reserve.  No  meddling  inquiries  should 
be  made — no  disingenuous  hints  given  relative  to  the  nature 
and  treatment  of  his  disorder ;  nor  any  course  of  conduct  pur- 
sued that  may  directly  or  indirectly  tend  to  diminish  the  trust 
reposed  in  the  physician  employed. 

Section  3.  The  same  circumspection  and  reserve  should 
be  observed  when,  from  motives  of  business  or  friendship,  a 
physician  is  prompted  to  visit  an  individual  who  is  under  the 
direction  of  another  practitioner.  Indeed,  such  visits  should 
be  avoided,  except  under  peculiar  circumstances ;  and  when 
they  are  made,  no  particular  inquiries  should  be  instituted 
relative  to  the  nature  of  the  disease,  or  the  remedies  em- 
ployed, but  the  topics  of  conversation  should  be  as  foreign  to 
the  case  as  circumstances  will  admit. 

Section  4.  A  physician  ought  not  take  charge  of  or  pre- 
scribe for  a  patient  who  has  recently  been  under  the  care  of 
another  member  of  the  faculty  in  the  same  illness,  except  in 
cases  of  sudden  emergency,  or  in  consultation  with  the  phy- 
sician previously  in  attendance,  or  when  the  latter  has  relin- 
quished the  case,  or  has  been  regularly  notified  that  his  serv- 
ices are  no  longer  desired.  Under  such  circumstances,  no 
unjust  and  illiberal  insinuations  should  be  thrown  out  in  re- 
lation to  the  conduct  or  practice  previously  pursued,  which 


203 

should  be  justified  as  far  as  candor  and  regard  for  truth  and 
probity  will  permit ;  for  it  often  happens  that  patients  be- 
come dissatisfied  when  they  do  not  experience  immediate  re- 
lief, and,  as  many  diseases  are  naturally  protracted,  the  want 
of  success,  in  the  first  stage  of  treatment,  affords  no  evi- 
dence of  a  lack  of  professional  knowledge  and  skill. 

Section  5.  When  a  physician  is  called  to  an  urgent  case, 
because  the  family  attendant  is  not  at  hand,  he  ought,  unless 
his  assistance  in  consultation  be  desired,  to  resign  the  care 
of  the  patient  to  the  latter  immediately  on  his  arrival. 

Section  6.  It  often  happens  in  case  of  sudden  illness,  or 
of  recent  accidents  and  injuries,  owing  to  the  alarm  and  anx- 
iety of  friends,  that  a  number  of  physicians  are  simultaneous- 
ly sent  for.  Under  these  circumstances,  courtesy  should  as- 
sign the  patient  to  the  first  who  arrives,  who  should  select 
from  those  present  any  additional  assistance  that  he  may 
deem  necessary.  In  all  such  cases,  however,  the  practitioner 
who  officiates  should  request  the  family  physician,  if  there 
be  one,  to  be  called,  and,  unless  his  further  attendance  be 
requested,  should  resign  the  case  to  the  latter  on  his  arrival. 

Section  7.  When  a  physician  is  called  to  the  patient  of 
another  practitioner,  in  consequence  of  the  sickness  or  ab- 
sence of  the  latter,  he  ought,  on  the  return  or  recovery  of  the 
regular  attendant  and  with  the  consent  of  the  patient,  to  sur- 
render the  case. 

[The  expression,  "patient  of  another  practitioner,"  is  un- 
derstood to  mean  a  patient  who  may  have  been  under  the 
charge  of  another  practitioner  at  the  time  of  the  attack  of 
sickness,  or  departure  from  home  of  the  latter,  or  who  may 
have  called  for  his  attendance  during  his  absence  or  sick- 
ness, or  in  any  other  manner  given  it  to  be  understood  that 
he  regarded  the  said  physician  as  his  regular  medical  at- 
tendant.] 

Section  8'.  A  physician,  when  visiting  a  sick  person  in 
the  country,  may  be  desired  to  see  a  neighboring  patient  who 
is  under  the  regular  direction  of  another  physician,  in  con- 
sequence of  some  sudden  change  or  aggravation  of  symp- 
toms. The  conduct  to  be  pursued  on  such  an  occasion  is  to 
give  advice  adapted  to  present  circumstances ;  to  interfere  no 


204 

further  than  is  absolutely  necessary  with  the  general  plan  of 
treatment ;  to  assume  no  future  direction  unless  it  is  ex- 
pressly desired ;  and,  in  this  last  case,  to  request  an  imme- 
diate consultation  with  tlie  practitioner  previously  employed. 

Section  9.  A  wealthy  physician  should  not  give  advice 
gratis  to  the  affluent ;  because  his  doing  so  is  an  injury  to  his 
professional  brethren.  The  office  of  a  physician  can  never  be 
supported  as  an  exclusively  beneficent  one ;  and  it  is  defraud- 
ing, in  some  degree,  the  common  funds  for  its  support,  when 
fees  are  dispensed  with  which  might  justly  be  claimed. 

Section  10.  When  a  physician  who  has  been  engaged  to 
attend  a  case  of  midwifery  is  absent,  and  another  is  sent  for, 
if  delivery  is  accomplished  during  the  attendance  of  the  lat- 
ter, he  is  entitled  to  the  fee,  but  should  resign  the  patient  to 
the  practitioner  first  engaged. 

Art.  VI. — Of  differences  between  physicians. 

Section  i.  Diversity  of  opinion  and  opposition  of  inter- 
est may,  in  the  medical  as  in  other  professions,  sometimes  oc- 
casion controversy  and  even  contention.  Whenever  such 
cases  unfortunately  occur,  and  cannot  be  immediately  termi- 
nated, they  should  be  referred  to  the  arbitration  of  a  suffi- 
cient number  of  physicians  or  a  court-medical. 

Section  2.  As  peculiar  reserve  must  be  maintained  by 
physicians  toward  the  public,  in  regard  to  professional  mat- 
ters, and  as  there  exist  numerous  points  in  medical  ethics 
and  etiquette  through  which  the  feelings  of  medical  men  may 
be  painfully  assailed  in  their  intercourse  with  each  other,  and 
which  cannot  be  understood  or  appreciated  by  general  so- 
ciety, neither  the  subject-matter  of  such  differences  nor  the 
adjudication  of  the  arbitrators  should  be  made  public,  as 
publicity  in  a  case  of  this  nature  may  be  personally  injurious 
to  the  individuals  concerned,  and  can  hardly  fail  to  bring 
discredit  on  the  faculty. 

Art.  VII. — Of  pecuniary  acknowledgments. 

Some  general  rules  should  be  adopted  by  the  faculty,  in 
every  town  or  district,  relative  to  pecuniary  acknowledge- 
ments from  their  patients ;  and  it  should  be  deemed  a  point  of 
honor  to  adhere  to  these  rules  with  as  much  uniformity  as 
varying  circumstances  will  admit. 


205 

OF  THE  DUTIES  OF  THE  PROFESSION  TO  THE  PUBLIC,  AND  OF 

THE  OBLIGATIONS  OF  THE   PUBLIC   TO 

THE   PROFESSION, 

Art.  I. — Duties  of  the  profession  to  the  public. 

Section  i.  As  good  citizens,  it  is  the  duty  of  physicians 
to  be  ever  vigilant  for  the  welfare  of  the  community,  and  to 
bear  their  part  in  sustaining  its  institutions  and  burdens; 
they  should  also  be  ever  ready  to  give  counsel  to  the  public 
in  relation  to  matters  especially  appertaining  to  their  pro- 
fession, as  on  subjects  of  medical  police,  public  hygiene,  and 
legal  medicine.  It  is  their  province  to  enlighten  the  public 
in  regard  to  quarantine  regulations;  the  location,  arrange- 
ment, and  dietaries  of  hospitals,  asylums,  schools,  prisons, 
and  similar  institutions ;  in  relation  to  the  medical  police  of 
towns,  as  drainage,  ventilation,  etc. ;  and  in  regard  to  meas- 
ures for  the  prevention  of  epidemic  and  contagious  diseases ; 
and  when  pestilence  prevails,  it  is  their  duty  to  face  the  dan- 
ger, and  to  continue  their  labors  for  the  alleviation  of  the 
suffering,  even  at  the  jeopardy  of  their  own  lives. 

Section  2.  Medical  men  should  also  be  always  ready, 
when  called  on  by  the  legally  constituted  authorities,  to  en- 
lighten coroners'  inquests  and  courts  of  justice  on  subjects 
strictly  medical — such  as  involve  questions  relating  to  san- 
ity, legitimacy,  murder  by  poisons  or  other  violent  means, 
and  in  regard  to  the  various  other  subjects  embraced  in  the 
science  of  Medical  Jurisprudence.  But  in  these  cases,  and 
especially  where  they  are  required  to  make  a  post-mortem 
examination,  it  is  just,  in  consequence  of  the  time,  labor,  and 
skill  required,  and  the  responsibility  and  risk  they  incur,  that 
the  public  should  award  them  a  proper  honorarium. 

Section  3.  There  is  no  profession  by  the  members  of 
which  elemosynary  services  are  more  liberally  dispensed  than 
the  medical,  but  justice  requires  that  some  limits  should  be 
placed  on  the  performance  of  such  good  offices.  Poverty, 
professional  brotherhood,  and  certain  of  the  public  duties  re- 
ferred to  in  the  first  section  of  this  article,  should  always  be 
recognized  as  presenting  valid  claims  for  gratuitous  services ; 
but  neither  institutions  endowed  by  the  public  or  by  rich  in- 
dividuals, societies  for  mutual  benefit,  for  the  insurance  of 


206 

lives  or  for  analogous  purposes,  nor  any  profession  or  occu- 
pation, can  be  admitted  to  possess  such  privilege.  Nor  can 
it  be  justly  expected  of  physicians  to  furnish  certificates  of 
inability  to  serve  on  juries,  to  perform  militia  duty,  or  to 
testify  to  the  state  of  health  of  persons  wishing  to  insure 
their  lives,  obtain  pensions,  or  the  like,  without  a  pecuniary 
acknowledgement.  But  to  individuals  in  indigent  circum- 
stances, such  professional  services  should  always  be  cheer- 
fully and  freely  accorded. 

Section  4.  It  is  the  duty  of  physicians,  who  are  frequent 
witnesses  of  the  enormities  committed  by  quackery,  and  the 
injury  to  health  and  even  destruction  of  life  caused  by  the 
use  of  quack  medicines,  to  enlighten  the  public  on  these  sub- 
jects, to  expose  the  injuries  sustained  by  the  unwary  from 
the  devices  and  pretensions  of  artful  empirics  and  impostors. 
Physicians  ought  to  use  all  the  influence  which  they  may  pos- 
sess, as  professors  in  Colleges  of  Pharmacy,  and  by  exercis- 
ing their  opinion  in  regard  to  the  shops  to  which  their  pre- 
scriptions shall  be  sent,  to  discourage  druggists  and  apothe- 
caries from  vending  quack  or  secret  medicines,  or  from  being 
in  any  way  engaged  in  their  manufacture  or  sale. 

Art.  II. — Obligations  of  the  public  to  physicians. 

Section  i.  The  benefits  accruing  to  the  public,  directly 
and  indirectly,  from  the  active  and  unwearied  beneficence  of 
the  profession,  are  so  numerous  and  important,  that  physi- 
cians are  justly  entitled  to  the  utmost  consideration  and  re- 
spect from  the  community.  The  public  ought  likewise  to  en- 
tertain a  just  appreciation  of  medical  qualifications;  to  make 
a  proper  discrimination  between  true  science  and  the  as- 
sumptions of  ignorance  and  empiricism ;  to  alTord  every  en- 
couragement and  faciHty  for  the  acquisition  of  medical  edu- 
cation— and  no  longer  allow  the  statute-books  to  exhibit  the 
anomaly  of  exacting  knowledge  from  physicians,  under  a  lia- 
bility to  heavy  penalties,  and  making  them  obnoxious  to 
punishment  for  resorting  to  the  only  means  of  obtaining  it. 

EXPLANATORY  DECLARATIONS. 

Whereas,  Persistent  misrepresentations  have  been  and 
still  are  being  made  concerning  certain  provisions  of  the 
Code  of  Ethics  of  this  Association,  by  which  many  in  the 


207 

community,  and  some  even  in  the  ranks  of  the  profession  are 
led  to  beHeve  those  provisions  exclude  persons  from  profes- 
sional recognition  simply  because  of  differences  of  opinions 
or  doctrines ;  therefore 

1.  Resolved,  That  clause  first,  of  Art.  IV.,  in  the  Na- 
tional Code  of  Medical  Ethics,  is  not  to  be  interpreted  as  ex- 
cluding from  professional  fellowship,  on  the  ground  of  dif- 
ferences in  doctrine  or  belief,  those  who  in  other  respects  are 
entitled  to  be  members  of  the  regular  medical  profession. 
Neither  is  there  any  other  article  or  clause  of  the  said  Code 
of  Ethics  that  interferes  with  the  exercise  of  the  most  per- 
fect liberty  of  individual  opinion  and  practice. 

2.  Resolved,  That  it  constitutes  a  voluntary  discon- 
nection or  withdrawal  from  the  medical  profession  proper, 
to  assume  a  name  indicating  to  the  public  a  sectarian,  or  ex- 
clusive system  of  practice,  or  to  belong  to  an  association  or 
party  antagonistic  to  the  general  medical  profession. 

3.  Resolved,  That  there  is  no  provision  in  the  National 
Code  of  Medical  Ethics  in  any  wise  inconsistent  with  the 
broadest  dictates  of  humanity,  and  that  the  article  of  the 
Code  which  relates  to  consultations  cannot  be  correctly 
interpreted  as  interdicting,  under  any  circumstances,  the  ren- 
dering of  professional  services  whenever  there  is  a  pressing 
or  immediate  need  of  them.  On  the  contrary,  to  meet  the 
emergencies  occasioned  by  disease  or  accident,  and  to  give 
a  helping  hand  to  the  distressed  without  unnecessary  delay, 
is  a  duty  fully  enjoined  on  every  member  of  the  profession, 
both  by  the  letter  and  the  spirit  of  the  entire  Code. 

But  no  such  emergencies  or  circumstances  can  make  it 
necessary  or  proper  to  enter  into  formal  professional  consul- 
tations with  those  who  have  voluntarily  disconnected  them- 
selves from  the  regular  medical  profession,  in  the  manner 
indicated  by  the  preceding  resolution. 

N.  S.  Davis,  of  Chicago, 
A.  Y.  P.  Garnett,  of  Washington, 
H.  F.  Campbell,  of  Augusta,  Ga., 
Austin  Flint,  of  New  York. 
J.  B.  Murdoch,  of  Pittsburgh. 


208 

On  motion  of  Dr.  Brodie,  the  resolutions  %yere  unani- 
mously adopted. 

On  motion  of  Dr.  Keller,  it  was  unanimously  agreed  that 
the  resolutions  be  added  as  an  explanatory  addendum  in  all 
future  publications  of  the  Code. 

Every  intelligent  and  thoughtful  reader  will  perceive 
that  the  foregoing  code  of  ethics  is  not  a  mere  system  of  by- 
laws, but  a  liberal  and  just  recognition  of  the  nature  and  ob- 
jects of  the  physician's  calling;  the  moral  principles  that 
should  govern  his  intercourse  with  his  patients,  with  his  pro- 
fessional brethren,  with  the  community  at  large ;  and  in  re- 
turn the  principles  that  should  influence  the  conduct  of  both 
the  patient  and  the  community  towards  the  profession. 

It  properly  assumes  that  injuries,  diseases,  pains  and 
death  are  conditions  of  distress  to  which  the  whole  human 
family  are  more  or  less  liable,  and  that  as  it  is  the  paramount 
object  of  both  physicians  and  surgeons  to  prevent  or  relieve 
such  distress  and  to  prolong  human  life,  it  is  their  duty  to 
promptly  and  faithfully  bestow  their  services  upon  all  who 
ask  them,  whether  rich  or  poor,  so  far  as  their  own  time  and 
health  will  permit.  It  also  assumes  that  inasmuch  as  "the 
laborer  is  worthy  of  his  hire"  so  the  physician  is  justly  en- 
titled to  a  fair  pecuniary  compensation  for  his  services  from 
all  who  are  able  to  pay ;  while  those  who  are  so  unfortunate 
as  to  be  both  sick  and  destitute,  should  also  be  treated  with 
all  the  kindness  and  faithfulness  that  their  cases  require. 

On  the  same  liberal  and  humane  principles  the  code 
makes  it  the  physician's  duty  to  enlighten  the  public  on  top- 
ics connected  with  the  public  health,  and  to  enlighten  the 
courts  on  all  medico-legal  questions  involved  in  the  adminis- 
tration of  justice. 

The  two  topics  that  have  given  rise  to  nearly  all  the  criti- 
cisms and  controversies  are  those  relating  to  advertising  and 
consultations.  Concerning  the  first,  the  code  freely  permits 
each  member  of  the  profession  to  place  his  name,  his  title, 
his  residence,  office  and  office  hours  on  his  cards  and  in  the 
newspapers  and  magazines  whenever  he  chooses  to  do  so. 
It  does,  however,  prohibit  him  from  resorting  "to  public  ad- 
vertisements, or  private  cards,  or  hand  bills,  inviting  the 


209 

attention  of  individuals  affected  with  particular  diseases", 
etc. ;  not  only  because  such  is  the  common  practice  of  em- 
pirics and  public  impostors,  but  also  because  the  indulgence 
in  such  practice  by  reputable  physicians  would  soon  fill  the 
newspapers  with  bombastic  and  pretentious  medical  adver- 
tisements with  no  profit  to  any  one  except  the  newspaper 
publisher  whose  chief  income  is  from  his  advertising  col- 
umns. And  it  would  also  make  it  still  more  difficult  for  the 
young  physician  to  establish  himself  in  practice,  because  he 
would  have  to  compete  in  the  advertising  line  with  his  older 
and  established  competitors  when  he  had  no  funds  to  spare 
for  such  a  purpose. 

Concerning  consultations,  the  code  enjoins  the  widest 
liberality  consistent  with  the  honor  of  the  profession  and  the 
welfare  of  the  patient.  It  assumes  that  in  all  consultations 
"the  good  of  the  patient  is  the  sole  object  in  view";  and 
therefore  no  intelligent,  legally  authorized  practitioner  who 
is  in  good  moral  and  professional  standing,  should  be  ex- 
cluded from  consultation,  except  those  who  base  their  prac- 
tice on  an  "exclusive  dogma"  or  theoretical  law  of  cure,  to 
the  exclusion  of  the  accumulated  experience  of  the  profes- 
sion, and  indicate  the  same  by  a  sectarian  title,  as  more  fully 
explained  in  the  resolutions  adopted  by  the  American  Med- 
ical Association  in  1869,  and  appended  to  the  preceding  copy 
of  the  Code  of  Ethics. 


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